Pharyngeal pouch surgery

The cost of this procedure depends on your individual circumstances. At the time of your appointment your consultant will discuss all options with you and ensure all your questions are answered.

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant’s outpatient appointment consultation fee are charged separately.

Our flexible payment options help you spread the cost of your payment across a time period that suits you.

The pharynx is a muscular tube in your neck that provides a passage from your nose and mouth to your main airways, oesophagus (food pipe or gullet) and larynx (voice box).

When you swallow, food passes from your mouth to your pharynx and into the upper part of your oesophagus before moving down to your stomach. A pharyngeal pouch can occur when there is a weakness in the muscle wall at the top part of your oesophagus, causing a pocket or sac to form.

A pharyngeal pouch is a relatively rare condition that typically affects people over the age of 70. Pharyngeal pouches are thought to affect around 0.01% to 0.11% of the population, though the actual number may be higher as many people do not have symptoms. The condition is around five times more common in men than women. 

It isn’t clear what causes a pharyngeal pouch to develop in some people. Pharyngeal pouches usually form in an area where there is a weakness in the muscle wall of the lower throat. There may be a link between developing a pharyngeal pouch and acid reflux in some people.

If your pharyngeal pouch is small, you may have mild or no symptoms and you may be unaware that you have it. If your pharyngeal pouch gets larger, food can start to collect in it, putting pressure on the opening of your oesophagus and making swallowing difficult (dysphagia).

Other symptoms of a pharyngeal pouch may include:

• Regurgitation of food that has collected in the pouch
• A choking sensation
• Chronic (long-term) cough
• Recurrent chest infections (uncommon) — may occur if food from the pouch enters the trachea (windpipe) and gets into your lungs 
• Bad breath (halitosis) from decaying food trapped in the pouch 
• Unintentional weight loss 
• Feeling a lump in your throat 
• Gurgling noises in your throat 
• Hoarse voice 

Your consultant may recommend surgery if your pharyngeal pouch is causing severe symptoms such as difficulty swallowing or recurrent chest infections. 

Pharyngeal pouch surgery aims to make swallowing easier, preventing problems such as recurring chest infections and weight loss.

Most pharyngeal pouches are not dangerous, but if your pharyngeal pouch becomes large, it can make swallowing difficult leading to unintentional weight loss. If your pharyngeal pouch is so severe that you cannot swallow, you may need to be fed through a feeding tube directly into your stomach.

Food from your pharyngeal pouch can also pass into your trachea (main airway) leading to a type of chest infection called aspiration pneumonia. Very rarely, cancer can develop in an untreated pharyngeal pouch that has been present for a long time.

At your first consultation, you will be seen by a consultant ear, nose and throat (ENT) or head and neck surgeon.

Your consultant will ask you about your symptoms, general health, medical history and any medications you are taking. They will perform a physical examination including checking your neck and throat to feel for any lumps or abnormalities.

Will I need tests or scans? 

A pharyngeal pouch is diagnosed using a procedure called a barium swallow. This involves swallowing a substance called barium that coats your throat and oesophagus. Special X-rays are taken while you swallow to produce real-time images of the barium passing through your oesophagus and into your stomach. This allows your consultant to assess your swallowing process and identify any abnormalities.

How is a diagnosis made?

Your consultant will make a diagnosis based on your symptoms, physical examination and the result of your barium swallow.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it’s where you meet your consultant, the doctor responsible for your care. Your consultant will spend time getting to know you, and discuss your symptoms, how they impact your life and your expectations for treatment. Your first appointment is also an opportunity for you to ask any questions you may have about your condition and possible treatment. It is important to us that you are as well-informed and comfortable as possible during your time with us, so please discuss any questions or concerns with your consultant during your appointment.

At the end of your appointment, your consultant will decide if pharyngeal pouch surgery is a suitable procedure for you based on your symptoms, diagnosis, general health and medical history. They will explain the procedure fully, including how to prepare for your surgery, what happens during the procedure, any possible risks or complications and what to expect during your recovery. 

Your consultant will tell you everything you need to do to prepare for your surgery. Instructions on how to prepare will also be in your appointment letter. If there’s anything you’re not sure about, or if you have any questions about how to prepare for your pharyngeal pouch surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines and supplements you are taking. 
Your consultant may tell you to stop taking some medications like blood thinners for a few days before and after your pharyngeal pouch surgery. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything from midnight on the day of your surgery.

Pharyngeal pouch surgery can either be performed endoscopically, through your mouth, or with open surgery through a cut in the side of your neck. It is carried out under general anaesthetic, meaning you’ll be asleep for the procedure.

Endoscopic surgery

This is a type of minimally invasive surgery, meaning your consultant will not need to make any incisions (cuts) during the procedure. During endoscopic surgery, your consultant passes an endoscope (a tube with a camera on the end) through your mouth into the top part of your oesophagus. They will then either use a special stapler or laser to close the pouch. The procedure also involves cutting the band of muscle (sphincter) at the top of your oesophagus to reduce the chance of a pouch developing again.

Endoscopic pharyngeal pouch stapling

After locating and examining the pharyngeal pouch using the endoscope, your consultant will staple the pouch closed. Endoscopic pharyngeal pouch stapling normally takes around 30 minutes.

Endoscopic laser cricopharyngeal myotomy (ECPM)

This procedure uses a laser to cut the muscle wall, preventing the muscle from contracting when swallowing. Endoscopic laser cricopharyngeal myotomy requires a longer stay in hospital than endoscopic stapling. This type of surgery normally takes between 30 minutes and one hour.

Open surgery

In some cases, such as if your pharyngeal pouch is particularly large, you cannot open your mouth wide enough for endoscopic surgery, or your neck is too stiff for the endoscope to reach the pouch, your consultant may recommend open surgery. This procedure may start as endoscopic surgery and progress to open surgery if endoscopic surgery is not possible. 

During open surgery, your consultant makes an incision in the side of your neck. The pharyngeal pouch is removed, and the tight muscle is released. After repairing any damage to your oesophagus, your consultant will stitch your incision closed.

Open pharyngeal surgery normally takes between one and two hours.

After your pharyngeal pouch surgery, you will be taken to the recovery room where you will be monitored carefully until the anaesthetic has worn off. You will then be taken to your room. If you had open surgery, you will have a drain in your neck when you wake up to drain any blood and fluids from your surgical wound.

If you had endoscopic laser cricopharyngeal myotomy (ELCM), you will have a feeding tube in your nose and will be fed through this until your oesophagus has healed.

We strongly recommend quitting smoking, or at least avoiding smoking for the first few weeks after pharyngeal pouch surgery as this can irritate your throat and delay healing.

Will I have pain after my pharyngeal pouch surgery?

You may have some mild pain or discomfort in your throat for a few days after your pharyngeal pouch surgery. Your healthcare team will give you painkillers to manage this. You may also have some bruising to your lips, gums, or tongue from where the endoscope was inserted. This will reduce gradually over the next few days.

How many nights will I need to stay in hospital?

How long you need to stay in hospital depends on the type of procedure you had and your individual recovery. 
After endoscopic stapling, you will probably need to spend one to two days in hospital. You can expect to stay in hospital for between two and five days after endoscopic laser cricopharyngeal myotomy and for between five and seven days after open surgery.

When can I eat after pharyngeal pouch surgery?

If you had endoscopic stapling surgery, you may be able to drink fluids a few hours after your surgery, moving to soft foods the next day and gradually returning to a normal diet over the next few days. For ELCM or open surgery, you will be fed through a feeding tube from your nose to your stomach until your oesophagus has fully healed. 
You may also need to have a barium swallow before eating and drinking to check that your throat has healed and that you can swallow effectively. You will be given liquids at first, followed by a few days of soft food, before gradually introducing normal food. Most patients can eat a normal diet after around a week.

Will I be able to drive home?

You will not be able to drive yourself home from the hospital after your pharyngeal pouch surgery. Please arrange for someone to collect you, or we can organise a taxi if you prefer. 

How soon can I go back to work?

When you can return to work after pharyngeal pouch surgery varies depending on the type of surgery you had, your individual recovery, and the type of job you do. You can expect to take at least ten days off work after your surgery, longer if you have a very active or manual job. You will need to rest and avoid strenuous activity for a few weeks after your surgery.

How soon can I drive?

You can drive when you can control your vehicle and perform an emergency stop. Do not drive for at least 24 hours after your surgery as the general anaesthetic may not have fully worn off and can affect your concentration and reaction times. Avoid driving while you are taking strong painkillers or any other medication that could impair your ability to drive safely.

When will I be back to normal?

Recovery from any type of surgery is a gradual process that is different for everyone. How long it takes to fully recover from pharyngeal pouch surgery depends on factors such as your age, general health, the type of surgery you had and your individual recovery.

You can help your recovery go more smoothly by taking it easy, listening to your body and following your consultant’s post-operative instructions carefully. Call the hospital if you have any questions or concerns during your recovery.

Your consultant will schedule a follow-up appointment to check your progress around four to six weeks after your surgery. 
Most people are back to normal a few weeks after pharyngeal pouch surgery. 

Pharyngeal pouch surgery is a generally safe procedure, and the risk of complications is low. However, as with all types of surgery, there is a small chance that complications can occur. Your consultant will explain any possible risks and complications before your surgery and answer any questions you may have. We want you to be fully informed about any potential risks and complications as this will allow you to make an informed decision.

Possible complications of any surgical procedure include:

• Bleeding
• Infection 
• Blood clots
• Chest infection 
• Adverse reactions to the anaesthetic 

In addition to the above, possible complications of pharyngeal pouch surgery include:

• Damage to your teeth or lips (if you had endoscopic surgery 
• Scarring 
• Swallowing difficulties — normally resolve in a few days, but may mean the pouch has reformed or that there is excessive scar tissue 
• A tear in your oesophagus or throat — this is rare but may require further surgery
• Mediastinitis — a rare, but serious complication that can occur if there is a tear in your oesophagus or throat and infection develops in the surrounding tissues  
• Damage to the laryngeal nerve — can occur with open surgery and may result in a weak or hoarse voice
• The pharyngeal pouch may come back

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about pharyngeal pouch surgery, book your appointment online today or call a member of our team directly on 0808 189 5499.

Pharyngeal pouch surgery - ENTUK

Pharyngeal pouch repair - Royal United Hospital Bath

Surgery to correct pharyngeal pouch - United Lincolnshire Hospitals NHS Trust

Pharyngeal pouch - Patient 

Pharyngeal pouch (Zenker's diverticulum) - PubMed