The procedure
Pouches over 2cm in size are amenable to surgery, although surgery on smaller pouches may be performed to help symptoms. The procedure can be performed through the mouth (endoscopic) or via a cut in the neck (open surgery). Endoscopic surgery involves a general anaesthetic, requires one night in hospital and involves opening the space between the pouch and oesophagus. This procedure should be tried before considering open surgery as it has lower risks, is equally effective and has a much shorter hospital stay. Open surgery requires a cut in the neck and removal of the pouch as well as division of one of the muscles around the top of the oesophagus. It may require up to a week in hospital and has more risks associated with it. This operation may be necessary to perform in the first instance in certain circumstances, if the pouch is very large.
The risks of an endoscopic division of pharyngeal pouch include:
- pain (managed with simple pain killers)
- bleeding
- infection and damage to your teeth, lips and gums during the procedure
- very occasionally, a perforation between the oesophagus and neck can occur and this may prolong your hospital stay
- rarely, the symptoms of the pouch can recur, or you may have on-going symptoms and revision surgery is required
Open procedures have the same risks as endoscopic operations as the pouch is filled with dressing so it can easily be located once the neck is opened. There will also be a scar on the outside of the neck (usually the left side). The risk of perforation is higher and there is a small chance the nerve to the voice box called the recurrent laryngeal nerve is damaged by the procedure causing a weaker or hoarse voice which could be temporary or permanent.
Post-operative information
After the procedure you will not be able to eat or drink for a few hours, following this you will start on liquids and soft food which can be built up to a normal diet over about 5 days. After 5-7 days, another swallow assessment will be performed to check everything has healed. Between the operation and the swallow assessment you will need a feeding tube to maintain nutrition and hydration.
Once discharged, simple pain relief is all that should be required. You will be seen in clinic around 8 weeks later to review your progress.