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Published in: Surgical Endoscopy 5/2004

01-05-2004 | Original article

Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results

Authors: A. Del Genio, G. Rossetti, V. Maffettone, A. Renzi, L. Brusciano, P. Limongelli, D. Cuttitta, G. Russo, G. Del Genio

Published in: Surgical Endoscopy | Issue 5/2004

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Abstract

Background

Thoracotomy represents the traditional surgical approach for the treatment of epiphrenic diverticula. A mini-invasive procedure has been reported in only few series. This article describes the authors’ experience with the laparoscopic approach for performing diverticulectomy, myotomy and Nissen–Rossetti fundoplication.

Methods

From 1994 to 2002, 13 patients (6 men and 7 women), mean age 57 years (range 45–71 years), with symptomatic epiphrenic diverticulum underwent laparoscopic diverticulectomy, myotomy, and Nissen–Rossetti fundoplication.

Results

The mean operative time was 145 min (range 110–180 min). No operative mortality was observed. The mean hospital stay was 13.9 days (range 7–25 years). The first three patients (23.1%) who underwent surgery experienced a partial disruption of the suture staple line. One patient (7.7%) died of a myocardial infarction. After a mean clinical follow-up period of 58 months (range 3–96 months), all the patients were symptom free.

Conclusions

Laparoscopic management of epiphrenic diverticula seems to be as safe and effective as the traditional approach, although a longer follow-up period is necessary to confirm the study results.
Literature
1.
go back to reference Allen, TH, Clagett, OT 1965Changing concepts in the surgical treatment of pulsion diverticula of the lower esophagus.J Thorac Cardiovasc Surg50455462PubMed Allen, TH, Clagett, OT 1965Changing concepts in the surgical treatment of pulsion diverticula of the lower esophagus.J Thorac Cardiovasc Surg50455462PubMed
2.
go back to reference Altorki, NK, Sunagawa, M, Skinner, DB 1993Thoracic esophageal diverticula: why is operation necessary?J Thorac Cardiovasc Surg105260264PubMed Altorki, NK, Sunagawa, M, Skinner, DB 1993Thoracic esophageal diverticula: why is operation necessary?J Thorac Cardiovasc Surg105260264PubMed
3.
go back to reference Belsey, RH 1966Functional disease of the esophagus.J Thorac Cardiovasc Surg52164188PubMed Belsey, RH 1966Functional disease of the esophagus.J Thorac Cardiovasc Surg52164188PubMed
4.
go back to reference Benacci, JC, Deschamps, C, Trastek, VF, Allen, MS, Daly, RC, Pairolero, PC 1993Epiphrenic diverticulum: results of surgical treatment.Ann Thorac Surg5511091113PubMed Benacci, JC, Deschamps, C, Trastek, VF, Allen, MS, Daly, RC, Pairolero, PC 1993Epiphrenic diverticulum: results of surgical treatment.Ann Thorac Surg5511091113PubMed
5.
go back to reference Del Genio, A, Izzo, G, Di Martino, N, Maffettone, V, Landolfi, V, Martella, A, Barbato, D 1997Intraoperative esophageal manometry (IEM): our experience.Dis Esophagus10253261PubMed Del Genio, A, Izzo, G, Di Martino, N, Maffettone, V, Landolfi, V, Martella, A, Barbato, D 1997Intraoperative esophageal manometry (IEM): our experience.Dis Esophagus10253261PubMed
6.
go back to reference Del Genio, A, Izzo, G, Maffettone, V, Di Martino, N, Fei, L, Zampiello, P, Allaria, A, Nuzzo, A 1994What is the degree of obstruction to swallowing created by the Nissen valve?Giuli, RTytgat, GNJDeMeester, TRGalmiche, JP eds. Esophageal mucosa.Elsevier Science Publishers BVAmsterdam623629 Del Genio, A, Izzo, G, Maffettone, V, Di Martino, N, Fei, L, Zampiello, P, Allaria, A, Nuzzo, A 1994What is the degree of obstruction to swallowing created by the Nissen valve?Giuli, RTytgat, GNJDeMeester, TRGalmiche, JP eds. Esophageal mucosa.Elsevier Science Publishers BVAmsterdam623629
7.
go back to reference Effler, DB, Barr, D, Groves, LK 1959Epiphrenic diverticulum of the esophagus: surgical treatment.Arch Surg79459467PubMed Effler, DB, Barr, D, Groves, LK 1959Epiphrenic diverticulum of the esophagus: surgical treatment.Arch Surg79459467PubMed
8.
go back to reference Evander, A, Little, AG, Ferguson, MK, et al. 1986Diverticula of the mid and lower esophagus: pathogenesis and surgical management.World J Surg10820828PubMed Evander, A, Little, AG, Ferguson, MK,  et al. 1986Diverticula of the mid and lower esophagus: pathogenesis and surgical management.World J Surg10820828PubMed
9.
go back to reference Fekete, F, Vonns, C 1992Surgical management of esophageal thoracic diverticula.Hepatogastroenterology399799PubMed Fekete, F, Vonns, C 1992Surgical management of esophageal thoracic diverticula.Hepatogastroenterology399799PubMed
10.
go back to reference Hudspeth, DA, Thorne, MT, Conroy, R, Pennell, TC 1993Management of epiphrenic esophageal diverticula: a fifteen-year experience.Am Surg594042PubMed Hudspeth, DA, Thorne, MT, Conroy, R, Pennell, TC 1993Management of epiphrenic esophageal diverticula: a fifteen-year experience.Am Surg594042PubMed
11.
go back to reference Jordan, PH, Kinner, BM 1999New look at epiphrenic diverticula.World J Surg23147152PubMed Jordan, PH, Kinner, BM 1999New look at epiphrenic diverticula.World J Surg23147152PubMed
12.
go back to reference Mondiere, JT 1833Notes sur quelques maladies de 1’oesophage.Arch Gen Med Paris32865 Mondiere, JT 1833Notes sur quelques maladies de 1’oesophage.Arch Gen Med Paris32865
13.
go back to reference Myers, BS, Dempsey, DT 1998Laparoscopic resection of esophageal epiphrenic diverticulum.J Laparoendosc Adv Surg Tech A8201207PubMed Myers, BS, Dempsey, DT 1998Laparoscopic resection of esophageal epiphrenic diverticulum.J Laparoendosc Adv Surg Tech A8201207PubMed
14.
go back to reference Nehra, D, Lord, RV, DeMeester, TR, Theisen, J, Peters, JH, Crookes, PF, Bremner, CG 2002Physiologic basis for the treatment of epiphrenic diverticulum.Ann Surg235346354CrossRefPubMed Nehra, D, Lord, RV, DeMeester, TR, Theisen, J, Peters, JH, Crookes, PF, Bremner, CG 2002Physiologic basis for the treatment of epiphrenic diverticulum.Ann Surg235346354CrossRefPubMed
15.
go back to reference Orringer, MB 1993Epiphrenic diverticula: fact and fable.Ann Thorac Surg5510671068PubMed Orringer, MB 1993Epiphrenic diverticula: fact and fable.Ann Thorac Surg5510671068PubMed
16.
go back to reference Peracchia, A, Bonavina, L, Rosati, R, Bona, S 1994Thoracoscopic resection of epiphrenic diverticula.Peters, JMeester, TR eds. Minimally invasive surgery of the foregut.QMP IncSt. Louis110116 Peracchia, A, Bonavina, L, Rosati, R, Bona, S 1994Thoracoscopic resection of epiphrenic diverticula.Peters, JMeester, TR eds. Minimally invasive surgery of the foregut.QMP IncSt. Louis110116
17.
go back to reference Raakow, R, Schmidt, S, Neuhaus, P 2002Laparoscopic transhiatal approach to epiphrenic diverticula.Chirurg734649CrossRef Raakow, R, Schmidt, S, Neuhaus, P 2002Laparoscopic transhiatal approach to epiphrenic diverticula.Chirurg734649CrossRef
18.
go back to reference Rosati, R, Fumagalli, U, Bona, S, Bonavina, L, Peracchia, A 1998Diverticulectomy, myotomy and fundoplication through laparoscopy: a new option to treat epiphrenic esophageal diverticula?Ann Surg227174178CrossRefPubMed Rosati, R, Fumagalli, U, Bona, S, Bonavina, L, Peracchia, A 1998Diverticulectomy, myotomy and fundoplication through laparoscopy: a new option to treat epiphrenic esophageal diverticula?Ann Surg227174178CrossRefPubMed
19.
go back to reference Rosati, R, Fumagalli, U, Bona, S, Zago, M, Celotti, S, Bisagni, P, Peracchia, A 2001Laparoscopic treatment of epiphrenic diverticula.J Laparoendosc Adv Surg Tech11371375CrossRef Rosati, R, Fumagalli, U, Bona, S, Zago, M, Celotti, S, Bisagni, P, Peracchia, A 2001Laparoscopic treatment of epiphrenic diverticula.J Laparoendosc Adv Surg Tech11371375CrossRef
20.
go back to reference Santy, P, Michaud, P, Viard, H 1958Les diverticules associés au megaesophage.Ann Chir12512519 Santy, P, Michaud, P, Viard, H 1958Les diverticules associés au megaesophage.Ann Chir12512519
21.
go back to reference Skinner, DB, Belsey, RH 1988Esophageal spasm and diverticulum.Management of esophageal disease.WB SaundersPhiladelphia431452 Skinner, DB, Belsey, RH 1988Esophageal spasm and diverticulum.Management of esophageal disease.WB SaundersPhiladelphia431452
22.
go back to reference Streitz, JM,Jr, Glick, ME, Ellis, FH 1992Selective use of myotomy for treatment of epiphrenic diverticula: manometric and clinical analysis.Arch Surg127585587PubMed Streitz, JM,Jr, Glick, ME, Ellis, FH 1992Selective use of myotomy for treatment of epiphrenic diverticula: manometric and clinical analysis.Arch Surg127585587PubMed
23.
go back to reference Peet, DL, Klinkenberg-Knol, EC, Berends, FJ, Cuesta, MA 2001Epiphrenic diverticula: minimal invasive approach and repair in five patients.Dis Esophagus146062CrossRefPubMed Peet, DL, Klinkenberg-Knol, EC, Berends, FJ, Cuesta, MA 2001Epiphrenic diverticula: minimal invasive approach and repair in five patients.Dis Esophagus146062CrossRefPubMed
24.
go back to reference Zaninotto, G, Anselmino, M, Costantini, M, Boccù, C, Merigliano, S, Rossi, M, Ancona, E 1995Myotomy of esophageal body.Ann Ital Chir66567577PubMed Zaninotto, G, Anselmino, M, Costantini, M, Boccù, C, Merigliano, S, Rossi, M, Ancona, E 1995Myotomy of esophageal body.Ann Ital Chir66567577PubMed
Metadata
Title
Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results
Authors
A. Del Genio
G. Rossetti
V. Maffettone
A. Renzi
L. Brusciano
P. Limongelli
D. Cuttitta
G. Russo
G. Del Genio
Publication date
01-05-2004
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 5/2004
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-003-9044-6

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