Mr ENYI OFO
Consultant ENT, Head & Neck, Thyroid and Parathyroid Surgeon
BSc (Hons) MBBS (Lond) DO-HNS FRCS (ORL-NHS) PhD
WHAT IS PHARYNGEAL POUCH?
A Pharyngeal pouch, also known as a Zenker’s diverticulum, is a bulge or pocket that develops in the top of your swallowing tube, or oesophagus, which balloons out into the neck due to increased pressure. It is caused either by uncoordinated swallowing and relaxation of the muscles in the throat, or by chronic acid reflux. It occurs more often in older patients (over the age of 65).
SYMPTOMS OF PHARYNGEAL POUCH
Most patients with pharyngeal pouches have mild or no symptoms. However, it can be associated with the feeling of a lump in the throat, persistent coughing when eating, difficulty swallowing, gurgling noises in the throat, regurgitation of food, aspiration of food, bad breath and weight loss.
The management of a pharyngeal pouch is dependent on the symptoms experienced and severity, the size of the pouch, age of the patient, and the expected outcome from surgery.
Various techniques are employed to manage this condition, and include:
Endoscopic stapling technique – Dohlman’s procedure (Least invasive)
Endoscopic laser treatment.
An open surgical procedure through the neck to excise the pouch.
COMPLICATIONS OF SURGERY
As with any operation, complications can arise. Endoscopic pharyngeal pouch stapling is performed under a general anaesthetic and usually requires at most an overnight stay in hospital. Because the procedure is minimally invasive, is well tolerated by most patients. However, recognised complications include, infection, bleeding, dental or lip trauma, failure to staple pouch due to limited oral access, and oesophageal perforation causing infection in the chest (mediastinitis). In some cases, a recurrence of the pouch and or symptoms may occur.
AFTER THE PROCEDURE
Patients are usually discharged on the same day of surgery, although a small number may be required to stay for a night for further observations. You will be advised to stay off work for a period of one to two weeks to minimise bleeding or catching an infection. Medication to relieve symptoms of pain will be advised.