Epiphrenic diverticula: when and how to operate?

Martín, David Ruiz de Angulo; Escandell, M Ángeles Ortiz; Haro, Luisa F. Martínez de; Munítiz, Vicente; Paricio, Pascual Parrilla

doi:10.1016/s2173-5077(09)70134-6

Cited by 6 publications

(9 citation statements)

References 59 publications

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“…However, to date, there is no definitive conclusion on the physiopathology of this disease, whilst diffuse agreement exists about restriction of surgical indications only to symptomatic patients [8,9]. Different procedures have been described in literature.…”

Section: Discussionmentioning

confidence: 99%

Robotic transhiatal excision of epiphrenic diverticula

et al. 2016

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An epiphrenic oesophageal diverticulum is most commonly a pulsion diverticulum which develops consequent to protrusion of mucosa through the muscular wall of the distal oesophagus. Most of them are associated with underlying oesophageal motility disorders. The predominant symptoms are dysphagia with regurgitation, and sometimes retrosternal pain, if accompanied by spasm of the oesophagus. Surgical management is recommended for symptomatic patients. Traditional procedures include thoracotomy or laparotomy with excision of the diverticula, but these are associated with high morbidity. Laparoscopic approach is a safe treatment option associated with lesser morbidity. Here, we present a case of epiphrenic diverticulum which was treated by the robotic approach without any complication. There was also no associated motility abnormality in our case so fundoplication was not done. Robotic surgery is a useful tool while operating near the hiatus and gastro-oesophageal junction. We consider transhiatal robotic approach as a safe and easy approach for surgery of epiphrenic diverticulum.

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Section: Discussionmentioning

confidence: 99%

Robotic transhiatal excision of epiphrenic diverticula

et al. 2016

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“…The standard surgical approach for most of the authors is diverticulectomy, esophageal myotomy and antireflux procedure, even though other surgical strategies are reported, such as diverticulectomy alone, diverticulectomy and myotomy without antireflux procedure, myotomy alone or esophagectomy (21)(22)(23)(24)(25). The advent of minimally invasive techniques, in the last twenty years, has favored the diffusion of the transhiatal approach (26). The first laparoscopic diverticulectomy was reported by Rosati et al in 1998, with associated myotomy and Dor fundoplication in four patients with epiphrenic diverticulum.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are some technical disadvantages which are challenging even for expert minimally invasive surgeons. The dissection of the upper part of the diverticulum and a correct myotomy, though, may be difficult to perform because of the narrow space of the mediastinum and the rigid characteristics of the laparoscopic instruments (15,26). These steps appear to be less challenging if performed by the da Vinci Ò Surgical System, due to the advantage offered by the stereoscopic endoscope, the wide articulation of the robotic instruments and the 3D view.…”

Section: Discussionmentioning

confidence: 99%

Fully robotic treatment of an epiphrenic diverticulum: Report of a case

Pernazza

Mikaelian

Pende

et al. 2011

Minimally Invasive Therapy & Allied Technologies

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Epiphrenic diverticula are rare protrusions of the distal esophagus attributed to esophageal motility disorders or obstructive diseases. In presence of a relevant symptomatology, surgery is mandatory. Although many reports confirm the feasibility of the laparoscopic transhiatal approach, the mobilization of the esophagus and the myotomy appear challenging. The intrinsic characteristics of the da Vinci Robotic System could facilitate the approach to the esophagogastric junction and an extended mobilization of the esophagus. We describe a robotic transhiatal surgical treatment of an epiphrenic diverticulum with a Dor antireflux procedure. Robotic-assisted diverticulectomy appears feasible and safe with a low risk of esophageal perforation and pleura damage.

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“…Left posterolateral thoracotomy followed by diverticulectomy, esophageal myotomy, and an antireflux procedure has generally been considered the surgical technique of choice for treating epiphrenic diverticula 7 . Nevertheless, the abdominal approach has gained a large number of followers, particularly at the expense of the laparoscopic approach, because it proves safe and efficient when it is performed by experienced surgeons 8 .…”

Section: Discussionmentioning

confidence: 99%

Zenker's and epiphrenic diverticula in a patient with cutis laxa: should the surgical technique be modified?

Angulo

Haro

Ortiz

et al. 2010

Diseases of the Esophagus

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Currently, most of esophageal diverticula arise as the result of a pulsion effect. Some esophageal motor disorders increase the intraluminal pressure and after some time, the diverticula grow through a weak point of esophageal wall. In these cases, the surgical treatment of choice is the myotomy associated with diverticulopexy or diverticulectomy. Adding a fundoplication is accepted to avoid the consequences of gastroesophageal reflux after myotomy in the epiphrenic diverticula surgery. There are other causes of esophageal diverticula that change the resistance of esophageal wall. Cutis laxa, a congenital or acquired connective disease, is a strange one. In our patient, a good result was reached modifying the standard technique accord to its ethiopathogenic mechanism.

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Epiphrenic diverticula: when and how to operate?

Cited by 6 publications

References 59 publications

Robotic transhiatal excision of epiphrenic diverticula

Robotic transhiatal excision of epiphrenic diverticula

Fully robotic treatment of an epiphrenic diverticulum: Report of a case

Zenker's and epiphrenic diverticula in a patient with cutis laxa: should the surgical technique be modified?

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