MANAGEMENT OF EPIPHRENIC ESOPHAGEAL DIVERTICULA - A 15-YEAR EXPERIENCE

Epiphrenic esophageal diverticula represent an unusual cause of dyspha gia, pain, and weight loss. Although commonly associated with motility disorders, distal esophageal diverticula also have been associated wi th reflux strictures or other lesions. To determine the most appropria te diagnostic evaluation and operative approach, we reviewed the recen t 15-year experience with epiphrenic esophageal diverticula at our ins titution. Over the study period, 18 patients were diagnosed with pulsi on epiphrenic diverticula. Nine patients (50%) with symptomatic divert icula were referred for surgical management. All referred patients wer e evaluated with preoperative manometry, endoscopy, and contrast esoph agography. Diverticulectomy was performed via posterolateral thoracoto my in all patients, combined with myotomy in the 6 patients (67%) with abnormal manometric results and in 2 patients with normal manometric results. The third patient with normal manometric results underwent si mple diverticulectomy. There was no operative mortality. One complicat ion, a small esophageal leak, was managed successfully by early reoper ation. All patients were free of dysphagia at discharge. Follow-up was obtained for 17 patients (94%) ranging from 3 months to 12 years. Goo d to excellent results (measured by relief of symptoms, weight gain, a nd absence of clinical recurrence) were seen in all 9 surgical patient s, 6 of 9 nonsurgical patients remained or became symptomatic. This ex perience demonstrates the efficacy of surgical management of symptomat ic epiphrenic esophageal diverticula. Diverticulectomy combined with s elective myotomy permits excellent operative results and resolution of associated symptoms.