SRS339 - Zenker’s diverticulum—case closed, or case open?

Abstract Introduction Endoscopic treatments offer minimally invasive techniques for management of Zenker’s Diverticulum (ZD) or Cricopharyngeal (CP) muscle dysfunction. Selected cases, may require open surgery due to patient or pouch factors. We describe our experience of managing ZD/CPMD with surgical images to depict how we manage an open surgical approach. Methods A retrospective case series was conducted at South Infirmary Victoria University Hospital. Theatre records from 2024–2025 were reviewed. ZD were classified using the Van Overbeek staging system. Results Twelve patients were included with 7 males and 5 females with a mean age of 73. Endoscopic surgery was attempted in all cases with 8 (67%) requiring no further management. Four (33%) subsequently required external approach surgery with diverticulectomy and CP myotomy due to anatomical limitations preventing safe endoscopic management. The Van Overbeek staging score did not correlate with need for open surgery (P > 0.05). All 4 patients (100%) demonstrated clinical and radiographic improvement with a return to normal diet within 10 days. Conclusions Endoscopic surgery is an effective first-line treatment for ZD. Anatomical features may preclude endoscopic surgery and open surgery offers a safe, effective alternative management strategy.