Transcervical Cricopharyngeal Myotomy
And Diverticulectomy or Suspension
1. Incise left neck along anterior sternocleidomastoid.
2. Retract muscle and sheath laterally.
3. Divide omohyoid, sternothyroid and sternohyoid to expose cervical
4. Expose diverticulum.
- located posterior to the cricoid, sheathed in fibrous tissues that
must be divided.
5. Longitudinal myotomy on posterolateral aspect of the cervical
- from just inferior to the base of the diverticulum, to the
- typically the muscle at the bottom of the divertic is thickened
- once released will see the divertic clearly.
- also divide the lower fibers of inferior pharyngeal constrictor
superiorly form base of divertic, for 1-2 cm.
- and bluntly dissect these to widely splay open the mucosa,
identifying any residual muscle fibres.
6. Suspend or excise the divertic.
- if <2cm suspend by tacking the tip with 3-0 prolene to
precervical fascia as high as necessary to upend the pouch.
- larger pouches should be divided with a TA stapler with a
52Fr bougie in the esophagus.
- check for leaks using a nasogastric tube and insufflating air with
incision filled with saline.
7. Perfect haemostasis, as can bleed when coughing or straining on
- small closed suction drain and approximate platysma and skin
Transoral endoscopic stapled
Attractive as no neck incision
But only suitable if large pouch (>3cm), patient can open mouth
widely, extend neck, and no malignancy in the pouch.
- warn of chipped teeth from the rigid scope.
See Cameron for details; not covered.