Minimally invasive therapy for epiphrenic diverticula: Systematic review of literature and report of six cases

Abstract

INTRODUCTION:Epiphrenic diverticula (ED) are infrequent and conventional surgical treatment entails aggressive open or transthoracic surgery. Minimally invasive treatment has changed the surgical approach but some surgical controversies are not resolved.OBJECTIVE:The objective of this study is to describe our experience in minimally invasive treatment of the ED and to perform a systematic review of the current literature in this subject.MATERIALS AND METHODS:We reviewed all data from the Hospital de Sant Pau, focusing on patients that underwent minimally invasive treatment for an ED since 1998 to date. Furthermore, we performed a systematic literature review focused on the minimally invasive approach for ED.RESULTS:A total of 6 patients have been treated (5 transhiatal and 1 with abdominal and thoracic approach). We found a predominance of males with a median age of 63. The diagnosis was made with an endoscopy, barium swallow and manometry. Half of the manometry results were pathologic. The surgical technique involved a diverticulectomy, myotomy and a Dor partial founduplication. Two patients that presented suture line leakage (SLL) were treated conservatively. No mortality was reported. The systematic review was carried out under the Preferred Reporting Items for Systematic Reviews and Meta-analyses scheme, with a total of 20 studies where 189 patients were found. No comparative or prospective randomised trials were found. Overall morbidity was 24%, with a SLL rate of 12%, hospital stay of 5 days and mortality of 1.5%. After a median follow-up of 42 months, 81.5% of the patients were asymptomatic.CONCLUSION:The minimally invasive approach for ED is a safe and feasible procedure.

Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker’s Oesophageal Diverticula

“…Seven studies utilised the thoracoscopic approach6 , 12 , 13 , 26 – 29 in 42 patients. Seven studies utilised laparoscopy alone11 , 30 – 35 in 204 patients.…”

Laparoscopic approach in the treatment of large epiphrenic esophageal diverticulum.

“…Usually it is located at the right side of the esophagus [ 4 , 5 ]. There is an estimated prevalence of 0.015% in the United States, 0.77% in Japan and up to 2% in Europe, but the true incidence is unknown as only 15–20% of patients are symptomatic, while a great number of cases are diagnosed incidentally during radiographic or endoscopic examinations performed for other reasons [ 6 , 7 ]. For the pathophysiology of esophageal diverticulum, muscle weakness of the esophagus, incomplete relaxation of the esophageal sphincter and increased pharyngeal pressure are important [ 2 , 8 ].…”

“…Standard treatment of the epiphrenic diverticulum includes diverticulectomy, esophageal myotomy and fundoplication [ 9 , 10 ]. Still there is no consensus on the type of surgical access, the length of the myotomy, or the type of antireflux technique [ 6 ].…”

Laparoscopic-thoracoscopic esophageal resection in the treatment of giant epiphrenic esophageal diverticulum (Ivor Lewis operation): Case report

“…According to the literature, their prevalence is 10–15% of all esophageal diverticula [ 1 , 2 ]. There is an estimated prevalence of 0.015% in the United States, 0.77% in Japan and up to 2% in Europe, but the true incidence is unknown as only small percentage of patients are symptomatic [ 3 , 4 ]. The etiology and pathogenesis of ED are not fully revealed [ 5 , 6 ].…”