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Background: Epiphrenic diverticula are extremely rare. Evidence-based treatment recommendations are scarce. The primary study outcome was to examine whether surgical treatment in patients with epiphrenic diverticula leads to improved quality of life by outweighing the perioperative risks compared with conservative treatment., Methods: All patients with an epiphrenic diverticula at our institution between 2001 and 2021 were retrospectively reviewed and followed-up using a specific questionnaire, including the Eating Assessment Tool, and Gastrointestinal Quality of Life Index quality-of-life scores., Results: Of 51 patients with epiphrenic diverticula, 28 had surgery and 23 had conservative treatment. The most common symptom at presentation was dysphagia. Although 16 patients underwent open surgery, 12 had minimally invasive procedures. A prophylactic stent was applied intraoperatively in 6 patients. The morbidity rate in surgically treated patients was 50% (14/28), with a leakage in 43% (12/28; 33% for prophylactic stenting). Mortality was nil. At a median follow-up of 139 months, patients with surgery had better outcomes than those without (ie, less dysphagia [6/12 vs 11/12; P = .025]), a less likely pathologic Eating Assessment Tool score (4/12 vs 9/12; P = .041), and a nonsignificant better Gastrointestinal Quality of Life Index score (122 vs 112; P = .929). The rate of recurrence/progression of symptoms was significantly higher for conservatively treated patients (11/18 vs 6/27 for any surgery; P = .008), as well as for patients with minimally invasive procedure (5/12 vs 1/15 for open surgery; P = .030)., Conclusion: Despite the high perioperative morbidity, surgical treatment of epiphrenic diverticula leads to an improved long-term quality of life and lower recurrence rates than conservative treatment., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Epiphrenic diverticulum (ED) is a pulsion pseudodiverticulum found in the distal 10 cm of the esophagus. Motility disorders are present in the majority of patients with ED explaining the pathophysiology of this rare disease. Achalasia is the most common underlying disorder. We present a review on the diagnosis and management of ED in the setting of achalasia., Methods: Literature review., Results: Symptoms are most related to the underlying motility disorder. The diagnostic workup should always include an upper digestive endoscopy and a barium esophagogram. Esophageal manometry identifies the motility disorder in most patients. Therapeutic options include laparoscopic, thoracoscopic and endoscopic procedures. While a myotomy must always be performed, diverticulectomy is not always necessary., Conclusions: Epiphrenic diverticulum is a rare condition whose pathophysiology involves an underlying motility disorder-achalasia in most cases. Symptoms usually include dysphagia, regurgitation, heartburn, and respiratory complaints and correlate with the motility disorder rather than the diverticulum per se. Upper digestive endoscopy and barium esophagogram are needed for the diagnosis-manometry may add useful information but is not imperative for the treatment. Laparoscopic Heller myotomy with a partial fundoplication is the procedure of choice, with satisfactory symptom relief and several advantages over the thoracic approach. Diverticulectomy may be performed in selected patients. Peroral endoscopic myotomy (POEM) are novel techniques, effective and minimally invasive that can be an option for patients unfit for surgery., (© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)

Epiphrenic oesophageal diverticulum is a rare disorder affecting the distal oesophagus. Surgical techniques for this condition evolve over time from open transthoracic and trans-abdominal approaches to minimally invasive surgery. We report a case of an 82-year-old male who presented with symptomatic epiphrenic oesophageal diverticulum over the last 1 year. He underwent laparoscopic transhiatal diverticulectomy, myotomy and anterior partial fundoplication and was discharged well. He remains asymptomatic after a follow-up of 6 months.

Epiphrenic diverticula are pulsion-type outpouchings of the distal esophagus associated with motility disorders. They can present with chronic symptoms of dysphagia, regurgitation, reflux, and aspiration. A prospectively collected surgical outcomes database was queried for patients who underwent surgical treatment of epiphrenic diverticula at a single institution between August 1997 and August 2018. Patient demographics, presenting symptoms, operative intervention, and perioperative data were retrospectively reviewed. Twenty-seven patients with a symptomatic epiphrenic diverticulum were identified. Abnormal esophageal motility was diagnosed in 16 patients (59.2%), most commonly achalasia (29.6%). All patients had a minimally invasive (26 laparoscopic, one thoracoscopic) diverticulectomy with no conversions to open required. Concurrent myotomy was performed in 88.9 per cent patients and anti-reflux procedure in 85.2 per cent patients. There was minimal morbidity with no esophageal leaks, mortalities, or recurrent diverticula noted after 35.8 months of follow-up. Dysphagia was the most common persistent symptom and occurred in 11.1 per cent; overall resolution of symptoms was achieved with surgery in 89.9 per cent of patients. As minimally invasive techniques have advanced, laparoscopic diverticulectomy seems to be an excellent surgical approach for symptomatic epiphrenic diverticula. Long-term resolution of symptoms was achieved in most patients, with a very low complication rate.

Surgery for Killian-Jamieson diverticulum of the esophagus is scarcely reported in the literature owing to the rarity of this entity. This is a case report of such a diverticulum and a description of the transcervical diverticulectomy that we performed on a 49-year-old lady. The patient was investigated for symptoms of gastroesophageal reflux disease and was diagnosed with a left-sided Killian-Jamieson diverticulum., (Copyright © 2015. Published by Elsevier Taiwan.)

Esophageal diverticula are comparatively rare. The majority are Zenker's diverticula but parabronchial and epiphrenic diverticula can also occur. Parabronchial diverticula are of low clinical relevance, whereas Zenker's and epiphrenic diverticula both belong to the group of pulsion diverticula and can become clinically apparent by dysphagia and regurgitation. Approximately 100 years after the first surgical treatment, peroral approaches (e.g. stapler dissection and flexible endoscopic diverticulotomy) have now achieved a certain level of importance. Both approaches are less invasive than the open approach but are evidently more prone to recurrences. Accordingly, traditional open diverticulectomy with cervical myotomy should be recommended to patients with a reasonable life expectancy and an acceptable operative risk. This holds particularly true for Brombart stages I-III of the disease, as complete myotomy cannot be achieved via the peroral access. The classical surgical treatment of epiphrenic diverticula is open or laparoscopic/thoracoscopic diverticulectomy with distal myotomy, mostly combined with an anterior partial fundoplication; however, the leakage rate is high and several alternative options are currently being evaluated.

A 47-year-old man was found to have a 3-cm epiphrenic esophageal diverticulum on an upper gastrointestinal (UGI) barium study. He developed the symptoms of heartburn approximately 12 months later. UGI endoscopy indicated non-erosive gastroesophageal reflux disease (NERD) and an epiphrenic esophageal diverticulum. A proton pump inhibitor (PPI) did not relieve the symptoms. An UGI barium study at that time showed that the epiphrenic esophageal diverticulum had enlarged to 7 cm, and esophageal manometry showed findings of achalasia and diffuse esophageal spasm (DES), thus vigorous achalasia was diagnosed. Resection of the epiphrenic esophageal diverticulum, myotomy, and fundoplication (the Heller-Dor procedure) were successfully performed and no postoperative symptoms were encountered.

An esophageal diverticulum is seen in a variety of gastroesophageal conditions, with most having an underlying motility disorder. The diverticulum is diagnosed by combining the patient's history, physical examination, computed tomographic chest scan, and barium radiography. We present an unusual case of a 43-year-old patient with a history of leiomyoma resection of the esophagus and an ensuing placement of a laparoscopic band for weight loss. One year after banding, persistent dysphagia led to the diagnosis of a large esophageal diverticulum. We believe that this esophageal diverticulum is the largest reported secondary to a laparoscopic band., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

With the advancement of minimally invasive techniques, the laparoscopic approach of the epiphrenic diverticula has gained widespread popularity and it is considered today the approach of choice in most cases. Unfortunately, the preoperative evaluation of patients with epiphrenic diverticula, and their surgical management, is still ill defined. The goal of this article is to highlight the evidence-based rationale for our standard preoperative evaluation and chosen surgical technique., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Epiphrenic diverticulum of the esophagus is an uncommon disease, and its pathogenesis remains unclear. Surgical repair of this disease is warranted only for symptomatic patients because treatment carries high risk of morbidity. Over the past decade, the laparoscopic approach to epiphrenic diverticulectomy has been shown to be safe and effective. The aim of the study was to describe our specific approach to the procedure and results. From 1994 to 2012, 30 patients with symptomatic epiphrenic diverticulum underwent laparoscopic surgery. There were no conversions to open surgery. The postoperative course was uneventful in 28 patients (93.3%). One patient had a suture line leak, which required repair through right thoracotomy, and 1 patient had a hemoperitoneum, which needed an open splenectomy. The median follow-up was 52 months (2-144). To date, no patient has presented with a recurrence. Laparoscopic transhiatal surgery is in our opinion the preferred approach to treatment of epiphrenic diverticulum of the esophagus. The procedure has proven to be feasible and safe in experienced hands. Long-term results, both clinical and with an objective evaluation, are satisfactory., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Introduction: Traditionally, epiphrenic diverticula have been managed through a left thoracotomy. With the advancement of minimally invasive techniques, a laparoscopic approach has gained widespread popularity. Unfortunately, the preoperative evaluation of patients with epiphrenic diverticula, and their surgical management, is still not well characterized., Discussion: The goal of this article is to illustrate our approach to patients with epiphrenic diverticula in terms of preoperative evaluation and surgical technique. The final discussion will focus on the evidence-based rationale for our preoperative assessment and surgical approach.

Unlabelled: We report thoracoscopically or laparoscopically successfully treated patients with giant mid-esophageal and epiphrenic diverticula. Four patients presented with significant dysphagia for solid food, retrosternal pain, regurgitation and weight loss. They underwent the following gastroenterologic investigations: barium swallow, esophagoscopy, bronchoscopy and esophageal pH- and manometry. In two patients just below the trachea bifurcation, sacciform mid-esophageal diverticula of 10 to 12 cm without significant esophageal motor alteration were diagnosed. In the other two patients 8-10 cm large epiphrenic diverticula were diagnosed--one of them was associated with achalasia., Surgical Treatment: The midesophageal diverticula were resected via thoracoscopic access. The mobilized diverticula were resected with endo-GIAs. Trans-hiatal laparoscopic approach was applied for the dissection and resection of epiphrenic diverticulum. In one patient the resection was completed with esophago-cardiomyotomy and anterior partial fundoplication. During the operations continuous endoluminal endoscopic control was provided. There were no intraoperative complications. Oral feeding was started on the 6th postoperative day after control esophagography. The thoracoscopic or trans-hiatal laparoscopic resection of esophageal diverticula is safe, reduces postoperative morbidity and helps rapid return to normal activity.

Introduction: As a rule, epiphrenic diverticulum occurs in combination with most diverse forms of dysfunction in the lower esophageal sphincter (LES) and/or in the esophagus itself. The main symptoms are dysphagia, pain, and regurgitation. The operation consists in myotomy, diverticulum resection, and partial fundoplication via abdominal or thoracic approach using conventional or minimally invasive technique. The main risk is postoperative suture dehiscence after diverticular resection. The present study was therefore undertaken to establish whether the operation succeeds in risk patients even without resection of the diverticulum., Patients and Methods: In the period from 1998 to 2001, six patients were investigated preoperatively by means of esophageal manometry, endoscopy, and radiological barium swallow. The four risk patients underwent only myotomy of the LES, if appropriate, in combination with laparoscopic partial fundoplication. Resection of the diverticulum by thoracoscopy or with conventional thoracic technique was also performed in the two patients with normal risk., Results: Three of the four risk patients showed normal postoperative courses after laparoscopic myotomy and rapidly became free of symptoms and were able to eat normally. One patient died perioperatively of pulmonary complications. After thoracic diverticulum resection, both patients developed postoperative suture dehiscence with a complicated course. Altogether, freedom from symptoms with regard to dysphagia and regurgitation could be attained in five out of six patients over a follow-up period of 6 to 25 months., Conclusion: In patients with epiphrenic diverticulum and disorder of LES function, myotomy alone without resection of the diverticulum may be sufficient to relieve or eliminate symptoms. Laparoscopy and the combination with partial fundoplication are the preferred techniques. In our opinion, this method must be considered in order to reduce the surgical risk in multimorbid and elderly patients.

Epiphrenic diverticulum of the esophagus is an uncommon disease. In the light of the benefits of minimally invasive treatment of such a functional disorder, we used the laparoscopic approach for resection of an epiphrenic diverticulum. We found that laparoscopic repair of symptomatic esophageal epiphrenic diverticula is a safe and effective technique with minimal postoperative pain and morbidity. It should be considered as an alternative to the traditional transthoracic approach, and may become the standard technique.

Diverticula in the middle and lower thirds of the esophagus are a rare disorder, frequently associated with esophageal motility disturbances. For symptomatic patients transthoracic diverticulectomy with or without Heller's myotomy is recommended. Here we report two cases of symptomatic esophageal diverticula which were both treated successfully by a laparoscopic transhiatal approach.

Epiphrenic diverticula are rare. The exact prevalence of this condition is unknown because asymptomatic patients are usually not discovered. Symptoms are more often the result of an esophageal motility disorder than the diverticulum itself and no correlation exists between the size of the diverticulum and the severity of symptoms. We present a patient suffering from dysphagia, chest pain, food retention and regurgitation because of an epiphrenic diverticulum. The current treatment of choice for symptomatic epiphrenic diverticula is diverticulectomy via a left thoracic approach. We performed a successful abdominal laparoscopic approach.

The true incidence of epiphrenic esophageal diverticulum is unknown. Traditionally, diverticulectomy via a left thoracic approach has represented the gold standard. Trans-hiatal esophageal dissection under laparoscopy is feasible, but has not, to our knowledge, been applied before in the treatment of epiphrenic esophageal diverticulum.