The treatment of a pharyngeal pouch is by excision of the pouch combined with myotomy - longitudinal division - of the cricopharyngeus. If the pouch is small, a myotomy may be all that is necessary. Approaches at the level of the cricoid cartilage or obliquely through the left sternomastoid have been used to excise the pouch. The neck of the sac is closed in two layers.
Pre-operatively, the patient is put on fluids for 24 hours, possibly with antibiotics, and warned that s/he will not be able to swallow immediately after the operation. A warning must also be given that the operation carries risks such as fistula formation, mediastinitis, inhalation pneumonia and recurrent laryngeal nerve damage.
Once the pouch has been excised, the patient is fed through a naso-gastric tube. Normal feeding is delayed until complete healing of the wound can be demonstrated by a barium meal swallow. This may not be for at least 5 days.
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