Abstract
Epiphrenic diverticula are a rare disease almost always associated with an underlying motility disorder of the esophagus, such as achalasia. Treatment of any underlying motility disorder must be included in the management of epiphrenic diverticula to prevent postoperative complications and recurrences. Therefore, the goal of this paper is to describe the pathophysiology, clinical presentation, and proper methods of diagnosis and treatment of patients with epiphrenic diverticula. In addition, we aim to provide an overview of the surgical management and discuss the indications for surgery and choice of surgical approach. In general, surgical intervention is favored for symptomatic patients and the optimal surgical approach depends on the size and location of the diverticulum. Surgery is not without seemingly high rates of morbidity when a myotomy is not performed together with the diverticulectomy, even in those with normal manometry. The risk of carcinoma is exceedingly rare and it is usually discovered at late stages; therefore, no surveillance programs have been established in asymptomatic patients with unresected diverticula.
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References
Soares R, Herbella FA, Prachand VN, Ferguson MK, Patti MG. Epiphrenic diverticulum of the esophagus. From pathophysiology to treatment. J Gastrointest Surg. 2010;14(12):2009–15.
Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg. 1966;52(2):164–88.
Effler DR, Barr D, Groves LK. Epiphrenic diverticulum of the esophagus: surgical treatment. Arch Surg. 1959;79:459–67.
Fernando HC, Luketich JD, Samphire J, et al. Minimally invasive operation for esophageal diverticula. Ann Thorac Surg. 2005;80(6):2076–80.
Nehra D, Lord RV, DeMeester TR, et al. Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg. 2002;235(3):346–54.
Melman L, Quinlan J, Robertson B, Brunt LM, Halpin VJ, 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;23:1337–41.
Tedesco P, Fisichella PM, Way LW, Patti MG. Cause and treatment of epiphrenic diverticula. Am J Surg. 2005;190:902–5.
Zaninotto G, Portale G, Costantini M, Zanatta L, Salvador R, Ruol A. Therapeutic strategies for epiphrenic diverticula: systematic review. World J Surg. 2011;35(7):1447–53.
Thomas ML, Anthony AA, Fosh BG, Finch JG, Maddern JG. Oesophageal diverticula. Br J Surg. 2001;88:629–42.
Bradley PJ, Kochaar A, Quraishi MS. Pharyngeal pouch carcinoma: real or imaginary risks? Ann Otol Rhinol Laryngol. 1999;108(11 Pt 1):1027–32.
Herbella FA, Dubecz A, Patti MG. Esophageal diverticula and cancer. Dis Esophagus. 2012;25(2):153–8.
Zaninotto G, Portale G, Costantini M, et al. Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg. 2008;12(9):1485–90.
Fisichella PM, Patti MG. From Heller to POEM (1914–2014): a 100-year history of surgery for achalasia. J Gastrointest Surg. 2014;18(10):1870–5.
Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc. 2007;21(5):713–8.
Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, 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(3):405–12.
Rawlings A, Soper N, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective randomized-controlled trial. Surg Endosc. 2012;26(1):18–26.
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(6):1023–30.
Stefanidis D, Richardson W, Farrell TM, Kohn GP, Augenstein V, Fanelli RD, Society of American Gastrointestinal and Endoscopic Surgeons. SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc. 2012;26(2):296–311.
Allaix ME, Borraez Segura BA, Herbella FA, Fisichella PM, Patti MG. Is resection of an esophageal epiphrenic diverticulum always necessary in the setting of achalasia? World J Surg. 2015;39(1):203–7. PMID: 25189454.
Fisichella PM, Pittman M, Kuo PC. Laparoscopic treatment of epiphrenic diverticula: preoperative evaluation and surgical technique. How I do it. J Gastrointest Surg. 2011;15(10):1866–71.
Kilic A, Schuchert MJ, Awais O, Luketich JD, Landreneau RJ. Surgical management of epiphrenic diverticula in the minimally invasive era. JSLS. 2009;13(2):160–4.
Fisichella PM. Laparascopic repair of epiphrenic diverticulum. Semin Thorac Cardiovasc Surg. 2012;24:223–8.
Rosati R, Fumagalli U, Elmore U, de Pascale S, Massaron S, Peracchia A. Long-term results of minimally invasive surgery for symptomatic epiphrenic diverticulum. Am J Surg. 2011;201(1):132–5.
Jalilvand A, Fisichella PM, Hiranyatheb P, Ferguson M. Treatment of epiphrenic diverticula. In: Fisichella PM, Soper NJ, Pellegrini CA, Patti MG, editors. The surgical treatment of benign esophageal disorders: the “Chicago approach”. London: Springer; 2014. p. 69–83.
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Fisichella, P.M., Jalilvand, A., Dobrowolsky, A. (2016). Achalasia and Epiphrenic Diverticulum. In: Fisichella, P., Herbella, F., Patti, M. (eds) Achalasia. Springer, Cham. https://doi.org/10.1007/978-3-319-13569-4_12
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DOI: https://doi.org/10.1007/978-3-319-13569-4_12
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