Eso try

Zenker's diverticulum is a pulsion (false) diverticulum at Killian’s dehiscence (between cricopharyngeus & inferior constrictor).

• Caused by UES dysfunction and incoordination
• Most common esophageal diverticulum

• Endoscopic stapling or myotomy
• Open surgery: Esophagomyotomy + diverticulectomy via left cervical incision

• Salivary fistula (4–24%)
• Recurrence (2.5–20%)

• Transhiatal esophagectomy (THE) carries a higher risk of RLN injury due to cervical dissection.
• Pulmonary complications are more common in transthoracic esophagectomy (TTE).
• Anastomotic leak rate is slightly lower in THE (7.6%) than TTE (9.4%).

• Less operative blood loss
• Reduced pulmonary complications
• Stapled anastomosis lowers leak rate (~3%)

Three-field esophagectomy involves cervical, mediastinal, and abdominal lymphadenectomy.

• Most disabling complication is severe bronchorrhoea due to airway injury or tracheobronchial irritation.
• Can lead to poor pulmonary hygiene and prolonged ICU stay.

• Pulmonary complications (atelectasis, pneumonia) occur in up to 32.8% of cases.
• Followed by arrhythmias and RLN injuries.
• Common due to prolonged anesthesia, thoracic manipulation, and reduced lung expansion post-op.

• Endoscopy with EUS helps evaluate depth of wall involvement and extent of stricture.
• Barium only shows luminal narrowing but not wall damage.
• EUS is crucial for planning resection vs. bypass.