Outcomes in modified transoral resection of diverticula for Zenker’s diverticulum

  • Attapon Junlapan
  • Sara Abu-Ghanem
  • C. Kwang Sung
  • Edward J. DamroseEmail author



Transoral resection of Zenker’s diverticulum (TORD) was first reported in 2010. We present results for our modified approach to transoral resection (MTORD)—full-thickness cricopharyngeal myectomy, diverticulum sac excision, and suture closure of the pharyngotomy—and evaluate its safety and efficacy compared to endoscopic stapling and open approaches.


A retrospective study was performed in patients who underwent transoral resection of Zenker’s diverticulum using MTORD, endoscopic stapler-assisted diverticulotomy (ESD), or trancervical diverticulectomy (TCD) from July 2009 to August 2017. Pre-operative evaluation included barium swallow and subjective characterization of swallowing dysfunction using the EAT-10 and Reflux Symptom Index (RSI). Complications, length of hospitalization, recurrence, and revision rates were also evaluated.


Of 92 patients reviewed, 18 underwent MTORD, 45 underwent ESD and 29 underwent TCD. Major complications were only observed in ESD and TCD. Recurrence which required revision surgery was only observed in ESD. EAT-10 and RSI scores significantly improved and RSI scores normalized post-operatively for all approaches in short-term (< 1 year) follow-up.


MTORD is a safe and effective option for complete Zenker’s diverticulectomy. Complication rates are low. To date, no patient has required reoperation, although more cases and longer term follow-up are needed for more complete comparison to ESD and traditional open excision.


Modified transoral resection of diverticulum Endoscopic laser approach Diverticulectomy Zenker’s diverticulum Outcomes Recurrence 



Our grateful appreciation is expressed to Yifei Ma, our consulting statistician, for his kind contributions.

Compliance with ethical standards

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The consent for participation may be required for the study.

Supplementary material

Supplementary material 1 (MP4 32564 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Attapon Junlapan
    • 1
    • 2
  • Sara Abu-Ghanem
    • 1
  • C. Kwang Sung
    • 1
  • Edward J. Damrose
    • 1
    Email author
  1. 1.Department of Otolaryngology-Head and Neck SurgeryStanford University School of MedicineStanfordUSA
  2. 2.Department of Otolaryngology-Head and Neck Surgery, Faculty of MedicineNaresuan UniversityPhitsanulokThailand

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