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Cause and treatment of epiphrenic diverticula.
Am J Surg. 2005 Dec; 190(6):891-4.AJ

Abstract

BACKGROUND

Epiphrenic diverticula of the esophagus are often associated with a concomitant esophageal motor disorder, which is thought to be the cause of the diverticulum and some of the patient's symptoms. At one time diverticula were best removed via a left thoracotomy, but now the operation can be performed laparoscopically in most cases. We hypothesized that: (1) a motor disorder is the underlying cause of the diverticulum; and (2) optimal treatment consists of laparoscopic resection of the diverticulum, a Heller myotomy, and Dor fundoplication.

METHODS

We performed a retrospective review of a prospectively collected database from a university hospital tertiary care center. Between June 1994 and December 2002, we evaluated 21 patients with epiphrenic diverticula. An associated motility disorder of the esophagus was found in 81% of patients (achalasia, 9%; diffuse esophageal spasm, 24%; nonspecific esophageal motility disorder, 24%; nutcracker esophagus, 24%). Seven (33%) of these patients, all with esophageal dysmotility, were referred for treatment. The laparoscopic operation entailed resection of the diverticulum (using an endoscopic stapler), a Heller myotomy, and a Dor fundoplication.

RESULTS

All operations were completed laparoscopically. The postoperative course of 6 patients was uneventful and they left the hospital after 72 +/- 21 hours. In 1 patient an acute paraesophageal hernia developed, which was repaired on the second postoperative day. Late follow-up (median 57 months) showed that all 7 patients were asymptomatic.

CONCLUSIONS

These data support the conclusions that: (1) a primary esophageal motility disorder is the underlying cause of most epiphrenic diverticula; and (2) laparoscopic treatment is successful and should be the method of choice. The diverticular neck can be exposed satisfactorily from the abdomen; a stapler inserted from this angle is better orientated to transect the neck than one inserted through a thoracoscopic approach. Furthermore, the myotomy and fundoplication are much more easily performed from the abdomen than from alternative approaches.

Authors+Show Affiliations

Department of Surgery, University of California San Francisco, San Francisco, CA, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16307941

Citation

Tedesco, Pietro, et al. "Cause and Treatment of Epiphrenic Diverticula." American Journal of Surgery, vol. 190, no. 6, 2005, pp. 891-4.
Tedesco P, Fisichella PM, Way LW, et al. Cause and treatment of epiphrenic diverticula. Am J Surg. 2005;190(6):891-4.
Tedesco, P., Fisichella, P. M., Way, L. W., & Patti, M. G. (2005). Cause and treatment of epiphrenic diverticula. American Journal of Surgery, 190(6), 891-4.
Tedesco P, et al. Cause and Treatment of Epiphrenic Diverticula. Am J Surg. 2005;190(6):891-4. PubMed PMID: 16307941.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cause and treatment of epiphrenic diverticula. AU - Tedesco,Pietro, AU - Fisichella,Piero M, AU - Way,Lawrence W, AU - Patti,Marco G, PY - 2005/04/11/received PY - 2005/08/08/revised PY - 2005/08/08/accepted PY - 2005/11/26/pubmed PY - 2006/1/4/medline PY - 2005/11/26/entrez SP - 891 EP - 4 JF - American journal of surgery JO - Am. J. Surg. VL - 190 IS - 6 N2 - BACKGROUND: Epiphrenic diverticula of the esophagus are often associated with a concomitant esophageal motor disorder, which is thought to be the cause of the diverticulum and some of the patient's symptoms. At one time diverticula were best removed via a left thoracotomy, but now the operation can be performed laparoscopically in most cases. We hypothesized that: (1) a motor disorder is the underlying cause of the diverticulum; and (2) optimal treatment consists of laparoscopic resection of the diverticulum, a Heller myotomy, and Dor fundoplication. METHODS: We performed a retrospective review of a prospectively collected database from a university hospital tertiary care center. Between June 1994 and December 2002, we evaluated 21 patients with epiphrenic diverticula. An associated motility disorder of the esophagus was found in 81% of patients (achalasia, 9%; diffuse esophageal spasm, 24%; nonspecific esophageal motility disorder, 24%; nutcracker esophagus, 24%). Seven (33%) of these patients, all with esophageal dysmotility, were referred for treatment. The laparoscopic operation entailed resection of the diverticulum (using an endoscopic stapler), a Heller myotomy, and a Dor fundoplication. RESULTS: All operations were completed laparoscopically. The postoperative course of 6 patients was uneventful and they left the hospital after 72 +/- 21 hours. In 1 patient an acute paraesophageal hernia developed, which was repaired on the second postoperative day. Late follow-up (median 57 months) showed that all 7 patients were asymptomatic. CONCLUSIONS: These data support the conclusions that: (1) a primary esophageal motility disorder is the underlying cause of most epiphrenic diverticula; and (2) laparoscopic treatment is successful and should be the method of choice. The diverticular neck can be exposed satisfactorily from the abdomen; a stapler inserted from this angle is better orientated to transect the neck than one inserted through a thoracoscopic approach. Furthermore, the myotomy and fundoplication are much more easily performed from the abdomen than from alternative approaches. SN - 0002-9610 UR - https://www.unboundmedicine.com/medline/citation/16307941/Cause_and_treatment_of_epiphrenic_diverticula_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9610(05)00714-2 DB - PRIME DP - Unbound Medicine ER -