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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
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.
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.
do Nascimento FA, Lemme EM, Costa MM. Esophageal diverticula: pathogenesis, clinical aspects, and natural history. Dysphagia. 2006;21:198–205.
Guyatt G, Gutterman D, Baumann MH, et al. Grading strength of recommendations and quality of evidence in clinical guidelines. Chest. 2006;129:174–181.
Zaninotto G, Portale G, Costantini M, et al. Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg. 2008;12:1485–1490.
Altorki NK, Sunagawa M, Skinner DB. Thoracic esophageal diverticula. Why is operation necessary? J Thorac Cardiovasc Surg. 1993;105:260–264.
Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg. 1966;52:164–188.
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.
Orringer MB. Epiphrenic diverticula: fact and fable. Ann Thorac Surg. 1993;55:1067–1068.
Fasano NC, Levine MS, Rubesin SE, Redfern RO, Laufer I. Epiphrenic diverticulum: clinical and radiographic findings in 27 patients. Dysphagia. 2003;18:9–15.
Nehra D, Lord RV, DeMeester TR, et al. Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg. 2002;235:346–354.
Hudspeth DA, Thorne MT, Conroy R, Pennell TC. Management of epiphrenic esophageal diverticula. A fifteen-year experience. Am Surg. 1993;59:40–42.
Klaus A, Hinder RA, Swain J, Achem SR. Management of epiphrenic diverticula. J Gastrointest Surg. 2003;7:906–911.
Jordan PH Jr, Kinner BM. New look at epiphrenic diverticula. World J Surg. 1999;23:147–152.
Castrucci G, Porziella V, Granone PL, Picciocchi A. Tailored surgery for esophageal body diverticula. Eur J Cardiothorac Surg. 1998;14:380–387.
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.
Fekete F, Vonns C. Surgical management of esophageal thoracic diverticula. Hepatogastroenterology. 1992;39:97–99.
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.
Fernando HC, Luketich JD, Samphire J, et al. Minimally invasive operation for esophageal diverticula. Ann Thorac Surg. 2005;80:2076–2080.
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.
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.
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.
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.
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.
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.
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.
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.
Neoral C, Aujesky R, Bohanes T, Klein J, Kral V. Laparoscopic transhiatal resection of epiphrenic diverticulum. Dis Esophagus. 2002;15:323–325.
Rosati R, Fumagalli U, Bona S, et al. Laparoscopic treatment of epiphrenic diverticula. J Laparoendosc Adv Surg Tech A. 2001;11:371–375.
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.
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.
Fraiji E, Jr., Bloomston M, Carey L, et al. Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum. Surg Endosc. 2003;17:1600–1603.
Tedesco P, Fisichella PM, Way LW, Patti MG. Cause and treatment of epiphrenic diverticula. Am J Surg. 2005;190:891–894.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag London Limited
About this chapter
Cite this chapter
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
Download citation
DOI: https://doi.org/10.1007/978-1-84996-492-0_35
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-84996-364-0
Online ISBN: 978-1-84996-492-0
eBook Packages: MedicineMedicine (R0)