Esophageal Diverticulum Surgery in Turkey: Techniques, Recovery and Cost

What is an esophageal diverticulum?

An esophageal diverticulum is a pouch that forms in the wall of the esophagus or at the junction between the throat and the esophagus. Food, liquid or mucus can collect inside it and cause symptoms. Diverticula can be single or multiple, and range from a few millimeters to several centimeters.

Three main types exist, depending on their location:

• Zenker's diverticulum forms where the throat meets the esophagus (pharyngo-esophageal diverticulum),usually when the muscle at the top of the esophagus relaxes poorly.
• Mid-esophageal diverticula form in the middle part of the esophagus, sometimes after inflammation of nearby lymph nodes or because of abnormal muscle contractions.
• Epiphrenic diverticula form just above the diaphragm and are often associated with an esophageal motility disorder.

What causes esophageal diverticula?

The exact cause is not always clear. Most often, abnormal esophageal movement and raised pressure inside the esophagus play a role.

• Poor relaxation of the muscle at the entrance of the esophagus (Zenker's diverticulum).
• Esophageal motility disorders, such as achalasia or spasm, mainly for epiphrenic diverticula.
• Traction from inflamed or scarred tissue in the chest, for some mid-esophageal diverticula.
• Weakening of the esophageal wall with age.

Together, these factors raise the pressure inside the esophagus and make it easier for a pouch to form in a vulnerable area.

What are the symptoms?

Symptoms depend on the size of the pouch and its location. Small diverticula often cause no symptoms.

Common signs include:

• Difficulty swallowing.
• Regurgitation of undigested food, sometimes hours after a meal.
• A sensation of food stuck in the throat.
• Persistent bad breath.
• Chest discomfort or pressure.
• Cough, or repeated respiratory infections when food particles enter the airway.
• Weight loss in more advanced cases.

See a doctor promptly if you cannot swallow, if you cough or choke when eating, or if you lose weight without trying.

Diagnosis of esophageal diverticula

Doctors combine several tests to confirm an esophageal diverticulum:

• Barium swallow X-ray: you drink a contrast liquid, and the images show the size, shape and position of the pouch and how food moves through the esophagus.
• Upper endoscopy: a thin flexible camera passed through the mouth lets the doctor look at the lining of the esophagus and rule out other lesions.
• Esophageal manometry: measures the pressure when you swallow and shows whether the esophageal muscles work normally. It is useful when a motility disorder is suspected.
• CT scan: gives detailed images of the pouch and of nearby organs when this is needed to plan surgery.

Treatment of esophageal diverticula in Turkey

Treatment depends on your situation: the size and location of the pouch, the symptoms, and any underlying swallowing disorder. The decision is based on symptoms rather than on size alone.

Small pouches without symptoms are usually only monitored. Pouches that cause significant swallowing difficulty, regurgitation or aspiration are treated with an endoscopic procedure or with surgery.

Observation and dietary measures

Chewing slowly, eating small portions and avoiding hard foods can ease symptoms. These measures do not remove the pouch. If a motility disorder is present, it is also treated.

Endoscopic treatment

For a Zenker's diverticulum, the surgeon can divide the wall shared by the pouch and the esophagus (endoscopic diverticulotomy),so that food drains into the esophagus. This is done through the mouth, without an external incision.

Surgical treatment

Surgery is considered when symptoms are significant, when the pouch is large or complicated, or when other treatments are not suitable. The main procedures are:

• Diverticulectomy removes the pouch. In some cases the pouch is fixed (diverticulopexy) or inverted instead.
• Myotomy divides the muscle fibers responsible for the raised pressure (the muscle at the top of the esophagus in Zenker's diverticulum, or the lower esophageal muscle in epiphrenic diverticulum). It is usually combined with the pouch procedure and reduces the risk of recurrence.

The surgeon chooses the technique according to the type of diverticulum and your general health.

Process of esophageal diverticulum surgery

Your surgeon first studies the diverticulum with a barium swallow, an endoscopy and, if needed, a CT scan, to choose the best approach for your case.

The operation is performed under general anesthesia.

For open or minimally invasive surgery, the steps typically are:

• Access through the neck, chest or abdomen, using open surgery or minimally invasive techniques with small incisions and a camera.
• Removal of the pouch (diverticulectomy),or fixation of the pouch (diverticulopexy) in some cases.
• Myotomy: the surgeon divides some esophageal muscle fibers to treat the cause and lower the chance of recurrence.
• Closing of the incisions with sutures.

For a Zenker's diverticulum, an endoscopic approach through the mouth, without external incision, may be used instead.

Turquie Santé sends your file to a partner digestive surgeon for a preliminary assessment before you travel.

Postoperative phase

After surgery, the team monitors your vital signs and any drains. The length of your hospital stay depends on the technique and on how you recover.

First weeks after surgery

The surgeon may check the repair with a swallow study before you start to eat. You then start with liquids and gradually move to soft foods as your esophagus heals. Some pain and swallowing difficulty are expected and are treated with medication.

Ongoing recovery

Your surgeon follows your progress with regular visits to detect problems early. Persistent swallowing difficulty or a narrowing of the esophagus may need further treatment, such as endoscopic dilation. You resume normal activities step by step, as your surgeon advises.

If you take prescribed medicines, never stop them on your own: your doctor decides what to continue.

Postoperative complications

Complications can occur after surgery for esophageal diverticula. Their frequency depends on the technique, the type of diverticulum and your general health. They include:

• Leak or fistula (an abnormal passage) at the repair site, which can lead to infection of the chest (mediastinitis) and may need further surgery.
• Bleeding from the surgical site.
• Infection of the incision.
• Injury to the recurrent laryngeal nerve, which can cause a hoarse voice, mainly with neck approaches.
• Narrowing (stricture) of the esophagus.
• Return of the pouch over time.

Contact your surgeon right away if you have fever, chest pain, difficulty swallowing or any other unusual symptom during your recovery.