What is Zenker’s septoplasty and why is it performed?

Zenker’s diverticulum (also known as an oesophageal pouch, grey arrow Figure A below) may cause difficulty with swallowing, choking attacks, regurgitation and halitosis (bad breath). Most of these symptoms are due to retention of food debris or liquids within the pouch.

Zenker’s septoplasty refers to the endoscopic treatment of the diverticulum for the purpose of reducing or eliminating symptoms.

A/Prof Efthymiou has an interest in treating Zenker's diverticulum and more than 15 years experience with endoscopic septoplasty and more recently Z-POEM.

The procedure of choice depends on many factors and it is equally important to understand that not all Zenker's diverticulae require treatment and not all swallowing problems are necessarily related to a Zenker's diverticulum.

What preparations are required?

An empty stomach is required for a thorough and safe examination of the upper gastrointestinal tract and to perform the septoplasty. Preparation is similar to Gastroscopy.

What happens during septoplasty?

Your doctor will first discuss the risks of the procedure with you and address any questions you may have. You will then meet your anaesthetist who will discuss all aspects of the anaesthetic. Following this you will be taken to the procedure room. You'll then lie on your side, and a needle will be placed in your hand or arm. This is used to administer the anaesthetic. Once you are completely asleep your doctor will pass the endoscope through your mouth and into the oesophagus, stomach and duodenum. A flexible feeding tube will be placed through the mouth and into the stomach (B, black arrow). This is attached to the side of your face using adhesive tape. The muscle ridge that separates the diverticulum from the oesophagus is then incised using endoscopic instruments (C and D) and the incision is closed using an endoscopic clip. The procedure usually takes around 30-45 minutes and you will then be taken to the recovery area.

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What happens after septoplasty?

You will be monitored until the anaesthetic has worn off. You are required to fast for two hours after the procedure. At that stage you will be examined by your doctor. If there are no complications the flexible feeding tube will be removed and you will be allowed to go home. A course of tablet antibiotics will be prescribed. Because of the anaesthetic, your judgement and reaction time will be impaired for the rest of the day. You will need someone to drive you home and stay with you. You will be required to have clear fluids for the rest of the day and provided you are well you will be able to start a liquid diet the following day. A soft diet maybe commenced the day after and should be maintained for 5 days after the procedure. Your usual diet may be commenced one week after the procedure.

What are the possible complications of septoplasty?

Although major complications after septoplasty are uncommon, it's important to recognise complications and treat them early. Contact your doctor immediately if you have a fever after the test or if you notice trouble swallowing or increasing throat, chest or abdominal pain, or bleeding, including black stools. Bleeding can occur up to two weeks after the procedure.If you have any concerns following your test, you should contact your doctor right away.