Treatment for symptomatic Zenker's diverticulum is surgical. This has greatly progressed in recent years and two surgical approaches are possible: the external or cervical approach, and the other, more recent, endoscopic approach. Both are based on sectioning the cricopharyngeal muscle. The majority of authors recommend an endoscopic approach in first line, reserving open surgery for cases in which exposure of the diverticular collar is impossible or endoscopic surgery has failed. There are therefore still indications for open surgery, and this technique must be perfectly mastered.