A pharyngeal pouch is an abnormal, pouch-like structure in the pharynx at the top of the oesophagus. The pharynx is the passage between the main airways and oesophagus. When food is swallowed it passes from the mouth to the pharynx and through to the upper oesophagus. Where a pouch has formed, some food will be collected as it passes through to the oesophagus.

The most common symptoms are difficulty in swallowing, regurgitation of food and choking during eating. It can also cause the sensation of a lump in the neck/throat, a hoarse voice, bad breath and, in extreme cases, can make it impossible to eat.

It is a rare condition, particularly among people under 40. It tends to occur in middle-aged and older adults, especially people in their 70s and 80s, and affects men more often than women.

Treating this condition usually involves surgery.

Diagnosis

This condition can be diagnosed using a test called a barium swallow, a special X-ray that highlights the inside of your mouth, pharynx, and oesophagus. Alternatively, an upper endoscopy, a procedure that involves using a thin tube with a camera on the end, can to look at the throat and oesophagus. 

Treatment

There are two types of Pharyngeal Pouch Surgery – the Dohlman’s Procedure or a Cricothyromyotomy. Your surgeon will advise which procedure will be most suitable. Both procedures will require a general anaesthetic.

The Dohlman’s Procedure is a minimally invasive technique. A tube with a camera on the end (an endoscope) will be passed into your mouth and into the upper oesophagus to examine the pouch. Some endoscopes are equipped with a laser, which is used to divide the wall of the pharyngeal pouch, while others staple the pouch closed using the adjacent tissue. Either method will remove pouch formation so that will no longer get caught. This operation also involves cutting muscle band (sphincter) at the top of the oesophagus reducing the chance that this problem re-occurs.

A Cricothyromyotomy is an open surgery. The surgeon makes an incision on the neck and then cuts down until he finds the pouch. The pouch is then removed or pushed into the oesophagus and, as above, the sphincter is cut to reduce the chance of recurrence.  

Following Surgery

After surgery you will be carefully monitored to make sure you are recovering from the anaesthetic.

Patients undergoing the minimally invasive technique may start to drink fluids on the day of the operation and gradually build up to normal food. You may need to stay in hospital for 1 night.

Patients undergoing the open surgery will often have a drain put in their neck whilst asleep. This is removed a day or 2 after the operation. Initially patients do not eat and drink but are fed through a tube which travels from the nose to the stomach, while the internal oesophagus wound is healing. Patients are normally discharged a few days following the operation.

Need Help?

At One Healthcare we can book you in to see a specialist ENT surgeon, usually within 48 hours, for an initial consultation. Pharyngeal Pouch Surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.