Treatment of Epiphrenic Diverticulum: How I Do It

Epiphrenic diverticulum is a rare esophageal disorder occurring as an outpouching of mucosa and submucosa through the muscular layers, within 10 cm above the cardia. As the majority of epiphrenic diverticula are asymptomatic, the real incidence varies because of a considerable number of cases detected incidentally during radiographic or endoscopic evaluation. Traditionally, the operation was performed through a left thoracotomy approach and the diverticulectomy was completed with esophago-cardial myotomy and a Belsey Mark IV fundoplication. Laparoscopy offers many advantages in the treatment such as the possibility of extension of the myotomy from the lower esophagus through the stomach and the concomitant antireflux procedure to avoid postoperative reflux. The abdominal approach is also more comfortable for the patients and, as there is no need for transthoracic drains, is more tolerated in terms of postoperative pain. In this article, we do review our technique with all the steps of the operation illustrated by intraoperative pictures.