At first, Mary Jane Wurtz of Winfield began having trouble swallowing. After several months, she began regurgitating small bits of undigested food when she lay down at night. Curious, the 77-year-old researched her symptoms until she found an illustration in a medical encyclopedia of throat hernia, known as Zenker’s diverticulum.
A barium swallow test–an X-ray of the upper digestive tract–confirmed that she had the condition. After she heard about the traditional open-neck surgery to treat the condition, Wurtz probed further and eventually learned of a minimally invasive endoscopic technique performed at Loyola University Medical Center by Dr. Guy J. Petruzzelli, an otolaryngologist and head and neck surgeon. A handful of other institutions perform variations on the procedure.
The endoscopic procedure results in a shorter hospital stay, less pain and less chance of infection than the traditional procedure, according to Petruzzelli. It’s also a lot more pleasant, because the traditional procedure requires a four- to five-day hospital stay, a 3-inch incision in the middle of the neck, a tube up the nose and no eating for several days. What’s more, Loyola uses the same technique to treat patients with cancer of the throat and larynx, Petruzzelli said.
Zenker’s diverticulum occurs in 1 in 30,000 to 50,000 people, most often the elderly, Petruzzelli said. It occurs in men slightly more often than women and can take months or years to develop.
The condition occurs most often in northern European countries and in people whose heritage is northern European, such as those living in the United States, Canada and Australia. “Western high-fat, low-fiber diets may be contributing factors,” Petruzzelli said.
As people age and their tissues become lax, the muscular wall of the throat can develop weaknesses. Mucous membranes can protrude, or herniate, forming a sac. Food can become trapped, causing difficulties in swallowing, bad breath, regurgitation, weight loss, coughing, irritation and repeated bouts of pneumonia.
The most dangerous symptom is aspiration, in which food or liquid enters the windpipe and can cause a lung infection or pneumonia. If the sac grows, it can put pressure on the esophagus, the tube leading from the throat to the stomach.
In the endoscopic procedure, Petruzzelli inserts an endoscope–a small tube for viewing–into the patient’s mouth while the patient is under general anesthesia. Through the endoscope he passes a combined laser and microscope to divide the partition between the esophagus and sac. With part of the instrument in the esophagus and part in the sac, he uses the laser to cut and seal the partition. The sac then becomes part of the wall of the esophagus. There is no incision on the skin.
“The laser seals the edges of tissues, so no leakage of saliva can contaminate the neck,” Petruzzelli said. Saliva leakage can lead to life-threatening infections of the neck and chest. “We use a very precise microspot laser that does not injure normal tissues and a series of endoscopes and retractors that help keep the mouth open and tissues out of the way.”
Wurtz left the hospital the day after her surgery last summer. “I had a sore throat, and I was on a liquid diet for a week,” she said. She gradually began to eat soft foods and now has an unrestricted diet.
Today, Wurtz is practicing tai chi and watercolor painting. “My throat is fine,” she said. “There’s no regurgitation or coughing up of phlegm. The whole procedure was relatively painless too.”
“The procedure is a tremendous benefit to patients,” Petruzzelli said. “We see patients talking the day after surgery, whereas years ago they couldn’t talk for a week. Some folks have weight loss and lots of anxiety about eating in public. This procedure completely relieves all those symptoms.”
What remains to be seen is the long-term success rate of the endoscopic procedure.
According to Dr. Steven Charous, an otolaryngologist in Evanston and Glenview, research indicates the endoscopic approach requires less time in surgery, results in a speedier recovery and is tolerated more easily than the open approach but has less favorable results.
“With the open approach, 95 to 99 percent of patients will feel completely cured,” Charous said. “With the endoscopic approach, 80 percent will feel completely cured while the remainder may still have symptoms.”
The endoscopic technique has a higher reversion rate, he said.
“My associates and I perform the endoscopic approach on the right patient,” Charous said. “A sac can’t be too big or too small.”
Patients who cannot open their mouth widely or who have severe arthritis in their neck are not candidates for the endoscopic approach.
