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Management of Distal Esophageal Pulsion Diverticula

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Difficult Decisions in Thoracic Surgery

Abstract

Esophageal diverticular disease is an uncommon entity for which appropriate treatment remains somewhat controversial. The acquired diverticulum is typically classified by its location (upper, middle, epiphrenic) and pathogenesis (traction, pulsion). Traction diverticula have been ascribed to inflammation and adhesions from periesophageal lymph nodes arising from, for example, pulmonary tuberculosis or histoplasmosis. Pulsion diverticula arise from a number of factors, most notably esophageal dysmotility, functional or mechanical distal esophageal obstruction, and focal weakness of the esophageal wall.

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References

  1. Debas HT, Payne WS, Cameron AJ, Carlson HC. Physiopathology of lower esophageal diverticulum and its implications for treatment. Surg Gynecol Obstet. 1980;151:593–600.

    PubMed  CAS  Google Scholar 

  2. Evander A, Little AG, Ferguson MK, Skinner DB. Diverticula of the mid- and lower esophagus: pathogenesis and surgical management. World J Surg. 1986;10:820–828.

    Article  PubMed  CAS  Google Scholar 

  3. do Nascimento FA, Lemme EM, Costa MM. Esophageal diverticula: pathogenesis, clinical aspects, and natural history. Dysphagia. 2006;21:198–205.

    Article  PubMed  Google Scholar 

  4. Guyatt G, Gutterman D, Baumann MH, et al. Grading strength of recommendations and quality of evidence in clinical guidelines. Chest. 2006;129:174–181.

    Article  PubMed  Google Scholar 

  5. Zaninotto G, Portale G, Costantini M, et al. Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg. 2008;12:1485–1490.

    Article  PubMed  Google Scholar 

  6. Altorki NK, Sunagawa M, Skinner DB. Thoracic esophageal diverticula. Why is operation necessary? J Thorac Cardiovasc Surg. 1993;105:260–264.

    PubMed  CAS  Google Scholar 

  7. Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg. 1966;52:164–188.

    PubMed  CAS  Google Scholar 

  8. Benacci JC, Deschamps C, Trastek VF, Allen MS, Daly RC, Pairolero PC. Epiphrenic diverticulum: results of surgical treatment. Ann Thorac Surg. 1993;55:1109–1113.

    Article  PubMed  CAS  Google Scholar 

  9. Orringer MB. Epiphrenic diverticula: fact and fable. Ann Thorac Surg. 1993;55:1067–1068.

    Article  PubMed  CAS  Google Scholar 

  10. Fasano NC, Levine MS, Rubesin SE, Redfern RO, Laufer I. Epiphrenic diverticulum: clinical and radiographic findings in 27 patients. Dysphagia. 2003;18:9–15.

    Article  PubMed  Google Scholar 

  11. Nehra D, Lord RV, DeMeester TR, et al. Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg. 2002;235:346–354.

    Article  PubMed  Google Scholar 

  12. Hudspeth DA, Thorne MT, Conroy R, Pennell TC. Management of epiphrenic esophageal diverticula. A fifteen-year experience. Am Surg. 1993;59:40–42.

    PubMed  CAS  Google Scholar 

  13. Klaus A, Hinder RA, Swain J, Achem SR. Management of epiphrenic diverticula. J Gastrointest Surg. 2003;7:906–911.

    Article  PubMed  Google Scholar 

  14. Jordan PH Jr, Kinner BM. New look at epiphrenic diverticula. World J Surg. 1999;23:147–152.

    Article  PubMed  Google Scholar 

  15. Castrucci G, Porziella V, Granone PL, Picciocchi A. Tailored surgery for esophageal body diverticula. Eur J Cardiothorac Surg. 1998;14:380–387.

    Article  PubMed  CAS  Google Scholar 

  16. D’Ugo D, Cardillo G, Granone P, Coppola R, Margaritora S, Picciocchi A. Esophageal diverticula. Physiopathological basis for surgical management. Eur J Cardiothorac Surg. 1992;6:330–334.

    Article  PubMed  Google Scholar 

  17. Fekete F, Vonns C. Surgical management of esophageal thoracic diverticula. Hepatogastroenterology. 1992;39:97–99.

    PubMed  CAS  Google Scholar 

  18. D’Journo XB, Ferraro P, Martin J, Chen LQ, Duranceau A. Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum. Br J Surg. 2009;96:892–900.

    Article  PubMed  Google Scholar 

  19. Fernando HC, Luketich JD, Samphire J, et al. Minimally invasive operation for esophageal diverticula. Ann Thorac Surg. 2005;80:2076–2080.

    Article  PubMed  Google Scholar 

  20. Streitz JM Jr, Glick ME, Ellis FH Jr. Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis. Arch Surg. 1992;127:585–587.

    Article  PubMed  Google Scholar 

  21. Reznik SI, Rice TW, Murthy SC, Mason DP, Apperson-Hansen C, Blackstone EH. Assessment of a pathophysiology-directed treatment for symptomatic epiphrenic diverticulum. Dis Esophagus. 2007;20:320–327.

    Article  PubMed  CAS  Google Scholar 

  22. Melman L, Quinlan J, Robertson B, et al. Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula. Surg Endosc. 2009;23:1337–1341.

    Article  PubMed  Google Scholar 

  23. Varghese TK Jr, Marshall B, Chang AC, Pickens A, Lau CL, Orringer MB. Surgical treatment of epiphrenic diverticula: a 30-year experience. Ann Thorac Surg. 2007;84: 1801–1809.

    Article  PubMed  Google Scholar 

  24. del Genio A, Rossetti G, Maffetton V, et al. Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results. Surg Endosc. 2004;18:741–745.

    PubMed  Google Scholar 

  25. Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405–415.

    Article  PubMed  Google Scholar 

  26. Falkenback D, Johansson J, Oberg S, et al. Heller’s esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus. 2003;16:284–290.

    Article  PubMed  CAS  Google Scholar 

  27. 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;248:1023–1030.

    Article  PubMed  Google Scholar 

  28. Neoral C, Aujesky R, Bohanes T, Klein J, Kral V. Laparoscopic transhiatal resection of epiphrenic diverticulum. Dis Esophagus. 2002;15:323–325.

    Article  PubMed  CAS  Google Scholar 

  29. Rosati R, Fumagalli U, Bona S, et al. Laparoscopic treatment of epiphrenic diverticula. J Laparoendosc Adv Surg Tech A. 2001;11:371–375.

    Article  PubMed  CAS  Google Scholar 

  30. Allen TH, Clagett OT. Changing concepts in the surgical treatment of pulsion diverticula of the lower esophagus. J Thorac Cardiovasc Surg. 1965;50:455–462.

    PubMed  CAS  Google Scholar 

  31. van der Peet DL, Klinkenberg-Knol EC, Berends FJ, Cuesta MA. Epiphrenic diverticula: minimal invasive approach and repair in five patients. Dis Esophagus. 2001;14:60–62.

    Article  PubMed  Google Scholar 

  32. Fraiji E, Jr., Bloomston M, Carey L, et al. Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum. Surg Endosc. 2003;17:1600–1603.

    Article  PubMed  Google Scholar 

  33. Tedesco P, Fisichella PM, Way LW, Patti MG. Cause and treatment of epiphrenic diverticula. Am J Surg. 2005;190:891–894.

    Article  PubMed  Google Scholar 

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Chang, A.C. (2011). Management of Distal Esophageal Pulsion Diverticula. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Springer, London. https://doi.org/10.1007/978-1-84996-492-0_35

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  • DOI: https://doi.org/10.1007/978-1-84996-492-0_35

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