Transoral Incisionless Zenker’s Repair (Cricopharyngeal Myotomy)

Post-Operative Instructions

Casco Bay Surgery
10 Andover Road
Portland, Maine 04102
207-761-6642

Description of the Operation
We will be doing a Cricopharyngeal Myotomy (also called a Zenker’s Diverticulum Repair) for you. This involves dividing the sphincter muscle at the upper end of your esophagus. The sphincter doesn’t relax normally before surgery and is responsible for most of your swallowing trouble. The operation also divides the wall between the Zenker’s diverticulum and the esophagus to stop food and secretions from building up in the diverticulum. Depending on your anatomy, we will do this with either a surgical stapling device or a flexible electrical scalpel. Either way, we can usually do this operation using a video camera in the mouth without making an incision. Be prepared to spend one night in the hospital, although with the stapling technique you’ll probably be able to go home after just a few hours, depending upon how you feel after surgery.

Your Recovery
Because of the way your operation will be performed, we will put little or no restrictions on your physical activity after the operation. Your level of discomfort should prevent you from over-exerting yourself. Your discomfort will most likely be limited to a sore throat and should fade rapidly, so you should also be able to return to normal activities within a few days, depending on the activities. You may resume showering immediately.

Pain Relief

1. You might be comfortable using  just cough syrup or cough drops. If not, then take Extra Strength Tylenol (or generic acetaminophen) 500-1000mg every 4 hours as needed to control discomfort.

2. Take Advil (or generic ibuprofen) 600mg every 6 hours as needed for discomfort not controlled by Tylenol. [DO NOT use Advil if you have a history of stomach or intestinal ulcers or have had problems taking aspirin in the past.]

3. Take 1-2 oxycodone 5mg (or Dilaudid 2mg) tablets every 3 hours as needed for discomfort that remains after taking Tylenol & Advil. Most people will not need this, so we don’t always write a prescription for it. This is a narcotic pain killer. If you use it you must beware of becoming drowsy or inattentive, and you will not be able to drive or operate dangerous equipment. It can also cause nausea and constipation.

The above combination is for maximum pain control. You may skip some or all of the medications if you’re comfortable without them.

Other Medications

Resume taking your usual medications unless we instruct you otherwise.

Most Frequent Problems

•  Sore throat – Everybody has this to some degree. It should resolve within a few days. Occasionally the uvula (little piece of flesh that dangles from the back of the throat) will swell up and be annoying for a week or two, but it is not a health problem.

  Trouble swallowing – You should notice immediate improvement in your swallowing. You might still have some difficulty swallowing solid foods initially and possibly always. You will go home on a liquid diet and can advance it on your own. Most people should resume eating as though nothing has changed and gradually increase what they eat as they gain confidence that swallowing actually is better. At first, chew thoroughly and eat slowly. In general, the bigger the diverticulum is and the more difficulty swallowing before surgery, the greater the improvement will be immediately after surgery.

  Nausea – If you feel okay when you leave the hospital but start to feel nauseated at home, it is probably caused by the prescription pain killer. You might want to take only the Tylenol and Advil in that case or call me for a different prescription (which might also cause nausea). Prolonged vomiting or dry heaves soon after surgery puts more stress on the operation than we’d like.

Reasons to Call Casco Bay Surgery
•  Pain not controlled by your medication.
•  Persistent vomiting or dry heaves.
•  Fever and redness on your neck or the sensation that there is air under your skin when you massage your neck with your hand.
•  Any questions or concerns what-so-ever.

Post-Operative Office Appointment at Casco Bay Surgery  (207-761-6642)

Date:   _______________

Time:  _______________

We would like to see you in 3-4 weeks. Please call to confirm your appointment or to arrange one if you don’t have a date & time yet. If you don’t live near Portland and would like a telephone call instead of an office visit just let us know a few days before your appointment.

Last updated 7/1/13 rc