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Published in: Journal of Gastrointestinal Surgery 12/2010

01-12-2010 | Review Article

Epiphrenic Diverticulum of the Esophagus. From Pathophysiology to Treatment

Authors: Renato Soares, Fernando A. Herbella, Vivek N. Prachand, Mark K. Ferguson, Marco G. Patti

Published in: Journal of Gastrointestinal Surgery | Issue 12/2010

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Abstract

Introduction

Epiphrenic diverticula of the esophagus are usually associated with a concomitant esophageal motility disorder. The main symptoms experienced by patients are dysphagia, regurgitation, and aspiration. The best surgical treatment is still debated, particularly the need for a myotomy in addition to resection of the diverticulum.

Discussion

While for many decades the traditional approach was through a left thoracotomy, more recently, minimally invasive techniques have been successfully used and are now the procedure of choice in most cases. The purpose of this article was to review (a) the current understanding of the pathophysiology of epiphrenic diverticulum, (b) how this understanding should guide the surgical treatment, and (c) the surgical approach.
Literature
1.
go back to reference Mondiere JT. Notes sur quelques maladies de’loesophage. Arch Gen Med Paris 1833;3:28–65. Mondiere JT. Notes sur quelques maladies de’loesophage. Arch Gen Med Paris 1833;3:28–65.
2.
go back to reference Kausel HJ, Lindskog G. Epiphrenic diverticulum of the esophagus: a review of its surgical treatment and report of a case. Chest 1952;21:334–345. Kausel HJ, Lindskog G. Epiphrenic diverticulum of the esophagus: a review of its surgical treatment and report of a case. Chest 1952;21:334–345.
3.
4.
go back to reference Harrington S. The surgical treatment of pulsion diverticula of the thoracic esophagus. Ann Surg 1949;9:606–618. Harrington S. The surgical treatment of pulsion diverticula of the thoracic esophagus. Ann Surg 1949;9:606–618.
5.
go back to reference Effler DB, Barr D, Groves LK. Epiphrenic diverticulum of the esophagus—surgical treatment. Arch Surg 1959;79:459–467.PubMed Effler DB, Barr D, Groves LK. Epiphrenic diverticulum of the esophagus—surgical treatment. Arch Surg 1959;79:459–467.PubMed
6.
go back to reference Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg 1966;52:164–188.PubMed Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg 1966;52:164–188.PubMed
7.
go back to reference Nehra D, Lord RV, Demeester TR, Theisen J, Peters, JHMD, Crookes PF, Bremner CG. Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg 2002;235:346–354.CrossRefPubMed Nehra D, Lord RV, Demeester TR, Theisen J, Peters, JHMD, Crookes PF, Bremner CG. Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg 2002;235:346–354.CrossRefPubMed
8.
go back to reference Melman L, Quinlan J, Robertson B, Brunt LM, Halpin JV, Eagon JC, Frisella MM, Matthews BD. Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula. Surg Endosc 2009;23:1337–1341.CrossRefPubMed Melman L, Quinlan J, Robertson B, Brunt LM, Halpin JV, Eagon JC, Frisella MM, Matthews BD. Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula. Surg Endosc 2009;23:1337–1341.CrossRefPubMed
9.
go back to reference Benacci JC, Deschamps C, Trastek V, Allen MS, Daly RC, Pairolero PC. Epiphrenic diverticulum: results of surgical treatment. Ann Thorac Surg 1993;55:1109–1114.CrossRefPubMed Benacci JC, Deschamps C, Trastek V, Allen MS, Daly RC, Pairolero PC. Epiphrenic diverticulum: results of surgical treatment. Ann Thorac Surg 1993;55:1109–1114.CrossRefPubMed
10.
go back to reference Streitz JM, Glick ME, Ellis H. Archives of Surgery. Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis. Arch Surg 1992;127:585–588.PubMed Streitz JM, Glick ME, Ellis H. Archives of Surgery. Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis. Arch Surg 1992;127:585–588.PubMed
11.
go back to reference Del Genio A, Rossetti G, Maffettone V, Renzi A, Brusciano L, Limongelli P, Cuttitta D, Russo G, Del Genio G. Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results. Surg Endosc 2004;18:741–745.PubMed Del Genio A, Rossetti G, Maffettone V, Renzi A, Brusciano L, Limongelli P, Cuttitta D, Russo G, Del Genio G. Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results. Surg Endosc 2004;18:741–745.PubMed
12.
go back to reference Tedesco P, Fisichella PM, Way LW, Patti MG. Cause and treatment of epiphrenic diverticula. Am J Surg 2005;190:902–905.CrossRef Tedesco P, Fisichella PM, Way LW, Patti MG. Cause and treatment of epiphrenic diverticula. Am J Surg 2005;190:902–905.CrossRef
13.
go back to reference Fernando HC, Luketich JD, Samphire J, Alvelo-Rivera M, Christie NA, Buenaventura PO, Landreneau RJ. Minimally invasive operation for esophageal diverticula. Ann Thorac Surg 2005;80:2076–2081.CrossRefPubMed Fernando HC, Luketich JD, Samphire J, Alvelo-Rivera M, Christie NA, Buenaventura PO, Landreneau RJ. Minimally invasive operation for esophageal diverticula. Ann Thorac Surg 2005;80:2076–2081.CrossRefPubMed
14.
go back to reference Varghese TK, Marshall B, Chang AC, Pickens A, Lau CL, Orringer MB. Surgical treatment of epiphrenic diverticula: a 30-year experience. Ann Thorac Surg 2007;84:1801–1809.CrossRefPubMed Varghese TK, Marshall B, Chang AC, Pickens A, Lau CL, Orringer MB. Surgical treatment of epiphrenic diverticula: a 30-year experience. Ann Thorac Surg 2007;84:1801–1809.CrossRefPubMed
15.
go back to reference D'Journo XB, Ferraro P, Martin J, Chen LQ, Duranceau A. Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum. Br J Surg 2009;96:892–900.CrossRefPubMed D'Journo XB, Ferraro P, Martin J, Chen LQ, Duranceau A. Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum. Br J Surg 2009;96:892–900.CrossRefPubMed
16.
go back to reference Patti MG, Gorodner MV, Galvani C, Tedesco P, Fisichella PM, Ostroff JW, Bagatelos KC, Way LW. Spectrum of esophageal motility disorders: implications for diagnosis and treatment. Arch Surg 2005;140:442–448; discussion 448–9.CrossRefPubMed Patti MG, Gorodner MV, Galvani C, Tedesco P, Fisichella PM, Ostroff JW, Bagatelos KC, Way LW. Spectrum of esophageal motility disorders: implications for diagnosis and treatment. Arch Surg 2005;140:442–448; discussion 448–9.CrossRefPubMed
17.
go back to reference Altorki N, Sunagawa M, Skinner D. Thoracic esophageal diverticula. Why is the operation necessary? J Thorac Cardiovasc Surg 1993;105:260–264.PubMed Altorki N, Sunagawa M, Skinner D. Thoracic esophageal diverticula. Why is the operation necessary? J Thorac Cardiovasc Surg 1993;105:260–264.PubMed
18.
go back to reference Patti MG, Arcerito M, Tong J, De Pinto M, de Bellis M, Wang A, Feo CV, Mulvihill SJ, Way LW. Importance of preoperative and postoperative pH monitoring in patients with esophageal achalasia. J Gastrointest Surg 1997;1:505–510.CrossRefPubMed Patti MG, Arcerito M, Tong J, De Pinto M, de Bellis M, Wang A, Feo CV, Mulvihill SJ, Way LW. Importance of preoperative and postoperative pH monitoring in patients with esophageal achalasia. J Gastrointest Surg 1997;1:505–510.CrossRefPubMed
19.
go back to reference Hung JJ, Hsieh CC, Lin SC, Wang LS. Squamous cell carcinoma in a large epiphrenic esophageal diverticulum. Dig Dis Sci 2009;54:1365–1368.CrossRefPubMed Hung JJ, Hsieh CC, Lin SC, Wang LS. Squamous cell carcinoma in a large epiphrenic esophageal diverticulum. Dig Dis Sci 2009;54:1365–1368.CrossRefPubMed
20.
go back to reference Lee JH, Chae HS, Kim KH, Kim JW, Wang YP, Lee SH, Jo KH, Park JK, Sim SB, Yoon JS, Moon SW, Kim YH. Delayed primary repair of perforated epiphrenic diverticulum. J Korean Med Sci 2004;19:887–890.CrossRefPubMed Lee JH, Chae HS, Kim KH, Kim JW, Wang YP, Lee SH, Jo KH, Park JK, Sim SB, Yoon JS, Moon SW, Kim YH. Delayed primary repair of perforated epiphrenic diverticulum. J Korean Med Sci 2004;19:887–890.CrossRefPubMed
21.
go back to reference Abul-Khair MH, Khalil A, Mohsen A. Bleeding from an epiphrenic oesophageal diverticulum. Eur J Surg 1992;158:377–378.PubMed Abul-Khair MH, Khalil A, Mohsen A. Bleeding from an epiphrenic oesophageal diverticulum. Eur J Surg 1992;158:377–378.PubMed
22.
go back to reference Fasano NC, Levine MS, Rubesin SE, Redfen RO, Laufer I. Epiphrenic diverticula: clinical and radiographic findings. Dysphagia 2003;18:9–15.CrossRefPubMed Fasano NC, Levine MS, Rubesin SE, Redfen RO, Laufer I. Epiphrenic diverticula: clinical and radiographic findings. Dysphagia 2003;18:9–15.CrossRefPubMed
23.
go back to reference Debas HT, Payne WS, Cameron AJ, Carlson HC. Physiopathology of lower esophageal diverticulum and its implications for treatment. Surg Gynecol Obstet 1980;151:593–600.PubMed Debas HT, Payne WS, Cameron AJ, Carlson HC. Physiopathology of lower esophageal diverticulum and its implications for treatment. Surg Gynecol Obstet 1980;151:593–600.PubMed
24.
go back to reference Zaninotto G, Portale G, Costantini M, Merigliano S, Guirroli E, Rizzetto C, Rampado S, Ancona E. Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg 2008;12:1485–1490.CrossRefPubMed Zaninotto G, Portale G, Costantini M, Merigliano S, Guirroli E, Rizzetto C, Rampado S, Ancona E. Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg 2008;12:1485–1490.CrossRefPubMed
25.
go back to reference Rosati R, Fumagalli U, Bona S, Bonavina L, Peracchia A. Diverticulectomy, myotomy, and fundoplication through laparoscopy: a new option to treat epiphrenic esophageal diverticula? Ann Surg 1998;227:174–178.CrossRefPubMed Rosati R, Fumagalli U, Bona S, Bonavina L, Peracchia A. Diverticulectomy, myotomy, and fundoplication through laparoscopy: a new option to treat epiphrenic esophageal diverticula? Ann Surg 1998;227:174–178.CrossRefPubMed
26.
go back to reference Patti MG, Fisichella PM. Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia. How I do it. J Gastrointest Surg 2008;12:764–766.CrossRefPubMed Patti MG, Fisichella PM. Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia. How I do it. J Gastrointest Surg 2008;12:764–766.CrossRefPubMed
27.
go back to reference Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg 2003;138:490–495.CrossRefPubMed Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg 2003;138:490–495.CrossRefPubMed
28.
go back to reference Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 1999;230:587–593.CrossRefPubMed Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 1999;230:587–593.CrossRefPubMed
29.
go back to reference RichardsWO, Torquati A, Holzman MD, Khaitan L, ByrneD, Lutfi R, Sharp KW. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia. A prospective randomized double-blind clinical trial. Ann Surg 2004;240:405–415.CrossRefPubMed RichardsWO, Torquati A, Holzman MD, Khaitan L, ByrneD, Lutfi R, Sharp KW. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia. A prospective randomized double-blind clinical trial. Ann Surg 2004;240:405–415.CrossRefPubMed
30.
go back to reference Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 2008;248:1023–1030.CrossRefPubMed Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 2008;248:1023–1030.CrossRefPubMed
31.
go back to reference Fékéte F, Vonns C. Surgical management of esophageal thoracic diverticula. Hepatogastroenterol 1992;39:97–99. Fékéte F, Vonns C. Surgical management of esophageal thoracic diverticula. Hepatogastroenterol 1992;39:97–99.
32.
go back to reference Rosati R, Fumagalli U, Bona S, Zago M, Celotti S, Bisagni P, Peracchia A. Laparoscopic treatment of epiphrenic diverticula. J Laparoendosc Adv Surg Tech A 2001; 11(6):371–375.CrossRefPubMed Rosati R, Fumagalli U, Bona S, Zago M, Celotti S, Bisagni P, Peracchia A. Laparoscopic treatment of epiphrenic diverticula. J Laparoendosc Adv Surg Tech A 2001; 11(6):371–375.CrossRefPubMed
33.
go back to reference Klaus A, Hinder RA, Swain J, Achem SR. Management of epiphrenic diverticula. J Gastrointest Surg 2003;7:906–911.CrossRefPubMed Klaus A, Hinder RA, Swain J, Achem SR. Management of epiphrenic diverticula. J Gastrointest Surg 2003;7:906–911.CrossRefPubMed
34.
go back to reference Müller A, Halbfass HJ. Laparoscopic esophagotomy without diverticular resection for treating epiphrenic diverticulum in hypertonic lower esophageal sphincter. Chirurg 2004;75:302–306.CrossRefPubMed Müller A, Halbfass HJ. Laparoscopic esophagotomy without diverticular resection for treating epiphrenic diverticulum in hypertonic lower esophageal sphincter. Chirurg 2004;75:302–306.CrossRefPubMed
Metadata
Title
Epiphrenic Diverticulum of the Esophagus. From Pathophysiology to Treatment
Authors
Renato Soares
Fernando A. Herbella
Vivek N. Prachand
Mark K. Ferguson
Marco G. Patti
Publication date
01-12-2010
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 12/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-010-1216-9

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