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World Journal of Surgery

, Volume 39, Issue 7, pp 1614–1619 | Cite as

Achalasia and Epiphrenic Diverticulum

  • P. Marco FisichellaEmail author
  • Anahita Jalilvand
  • Adrian Dobrowolsky
Surgical Symposium Contribution

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 later stages; therefore, no surveillance programs have been established in asymptomatic patients with unresected diverticula.

Keywords

Motility Disorder Achalasia Staple Line Esophageal Manometry Partial Fundoplication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Soares R, Herbella FA, Prachand VN, Ferguson MK, Patti MG (2010) Epiphrenic diverticulum of the esophagus. From pathophysiology to treatment. J Gastrointest Surg. 14(12):2009–2015PubMedCrossRefGoogle Scholar
  2. 2.
    Belsey R (1966) Functional disease of the esophagus. J Thorac Cardiovasc Surg 52(2):164–188PubMedGoogle Scholar
  3. 3.
    Effler DR, Barr D, Groves LK (1959) Epiphrenic diverticulum of the esophagus: surgical treatment. Arch Surg 79:459–467PubMedCrossRefGoogle Scholar
  4. 4.
    Fernando HC, Luketich JD, Samphire J et al (2005) Minimally invasive operation for esophageal diverticula. Ann Thorac Surg 80(6):2076–2080PubMedCrossRefGoogle Scholar
  5. 5.
    Nehra D, Lord RV, DeMeester TR et al (2002) Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg 235(3):346–354PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Melman L, Quinlan J, Robertson B, Brunt LM, Halpin VJ, Eagon JC, Frisella MM, Matthews BD (2009) Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula. Surg Endosc 23:1337–1341PubMedCrossRefGoogle Scholar
  7. 7.
    Tedesco P, Fisichella PM, Way LW, Patti MG (2005) Cause and treatment of epiphrenic diverticula. Am J Surg 190:902–905CrossRefGoogle Scholar
  8. 8.
    Zaninotto G, Portale G, Costantini M, Zanatta L, Salvador R, Ruol A (2011) Therapeutic strategies for epiphrenic diverticula: systematic review. World J Surg 35(7):1447–1453. doi: 10.1007/s00268-011-1065-z PubMedCrossRefGoogle Scholar
  9. 9.
    Thomas ML, Anthony AA, Fosh BG, Finch JG, Maddern JG (2001) Oesophageal diverticula. Br J Surg 88:629–642PubMedCrossRefGoogle Scholar
  10. 10.
    Bradley PJ, Kochaar A, Quraishi MS (1999) Pharyngeal pouch carcinoma: real or imaginary risks? Ann Otol Rhinol Laryngol. 108(11 Pt 1):1027–1032PubMedCrossRefGoogle Scholar
  11. 11.
    Herbella FA, Dubecz A, Patti MG (2012) Esophageal diverticula and cancer. Dis Esophagus 25(2):153–158PubMedCrossRefGoogle Scholar
  12. 12.
    Zaninotto G, Portale G, Costantini M et al (2008) Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg. 12(9):1485–1490PubMedCrossRefGoogle Scholar
  13. 13.
    Fisichella PM, Patti MG (2014) From Heller to POEM (1914–2014): a 100-year history of surgery for Achalasia. J Gastrointest Surg. 18(10):1870–1875PubMedCrossRefGoogle Scholar
  14. 14.
    Wright AS, Williams CW, Pellegrini CA, Oelschlager BK (2007) Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc 21(5):713–718PubMedCrossRefGoogle Scholar
  15. 15.
    Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 240(3):405–412PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Rawlings A, Soper N, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM (2012) Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective randomized-controlled trial. Surg Endosc. 26(1):18–26PubMedCrossRefGoogle Scholar
  17. 17.
    Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M (2008) Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 248(6):1023–1030PubMedCrossRefGoogle Scholar
  18. 18.
    Stefanidis D, Richardson W, Farrell TM, Kohn GP, Augenstein V, Fanelli RD, Society of American Gastrointestinal and Endoscopic Surgeons (2012) SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc 26(2):296–311PubMedCrossRefGoogle Scholar
  19. 19.
    Allaix ME, Borraez Segura BA, Herbella FA, Fisichella PM, Patti MG (2015) Is resection of an esophageal epiphrenic diverticulum always necessary in the setting of achalasia? World J Surg 39(1):203–207. doi: 10.1007/s00268-014-2770-1
  20. 20.
    Fisichella PM, Pittman M, Kuo PC (2011) Laparoscopic treatment of epiphrenic diverticula: Preoperative evaluation and surgical technique. How I do it. J Gastrointest Surg. 15(10):1866–1871PubMedCrossRefGoogle Scholar
  21. 21.
    Kilic A, Schuchert MJ, Awais O, Luketich JD, Landreneau RJ (2009) Surgical management of epiphrenic diverticula in the minimally invasive era. JSLS 13(2):160–164PubMedCentralPubMedGoogle Scholar
  22. 22.
    Melman L, Quinlan J, Robertson B, Brunt LM, Halpin VJ, Eagon JC, Frisella MM, Matthews BD (2009) Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula. Surg Endosc 23:1337–1341PubMedCrossRefGoogle Scholar
  23. 23.
    Fisichella PM, Pittman M, Kuo PC (2011) Laparoscopic treatment of epiphrenic diverticula: preoperative evaluation and surgical technique. How I do it. J Gastrointest Surg. 15(10):1866–1871PubMedCrossRefGoogle Scholar
  24. 24.
    Fisichella PM (2012) Laparascopic repair of epiphrenic diverticulum. Semin Thorac Cardiovasc Surg. 24:223–228PubMedCrossRefGoogle Scholar
  25. 25.
    Rosati R, Fumagalli U, Elmore U, de Pascale S, Massaron S, Peracchia A (2011) Long-term results of minimally invasive surgery for symptomatic epiphrenic diverticulum. Am J Surg 201(1):132–135PubMedCrossRefGoogle Scholar
  26. 26.
    Fernando HC, Luketich JD, Samphire J, Alvelo-Rivera M, Christie NA, Buenaventura PO, Landreneau RJ (2005) Minimally invasive operation for esophageal diverticula. Ann Thorac Surg 80(6):2076–2080PubMedCrossRefGoogle Scholar
  27. 27.
    Jalilvand A, Fisichella PM, Hiranyatheb P, Ferguson M (2014) Treatment of epiphrenic diverticula. In: Fisichella PM, Soper NJ, Pellegrini CA, Patti MG (eds) The surgical treatment of benign esophageal disorders: the “Chicago approach”. Springer, London, pp 69–83CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • P. Marco Fisichella
    • 1
    Email author
  • Anahita Jalilvand
    • 2
  • Adrian Dobrowolsky
    • 3
  1. 1.Department of SurgeryBrigham and Women’s Hospital and Boston VA Healthcare System, Harvard Medical SchoolBostonUSA
  2. 2.Department of SurgeryThe Ohio State UniversityClevelandUSA
  3. 3.Department of SurgeryLoyola University Chicago, Health Sciences CampusMaywoodUSA

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