EPIPHRENIC DIVERTICULUM - RESULTS OF SURGICAL-TREATMENT

From 1975 to 1991, 112 patients (64 men and 48 women) were found to ha ve an epiphrenic diverticulum. Symptoms were absent or minimal in 71 p atients and incapacitating in 41. All patients with minimal symptoms w ere managed conservatively; 35 were available for follow-up, which ran ged from 1 to 25 years (median, 9 years). None of these 35 patients ha d clinically significant progression of symptoms. Surgical repair was done in 33 patients with incapacitating symptoms. Achalasia was presen t in 8 of the surgical patients (24.2%), diffuse esophageal spasm in 3 (9.1%), hypertensive lower esophageal sphincter alone in 1 (3.0%), an d nonspecific motor abnormalities of the esophageal body in 7 (21.2%). Diverticulectomy and esophagomyotomy were performed in 22 patients, d iverticulectomy alone in 7, esophageal resection in 3, and esophagomyo tomy alone in 1. Concomitant hiatal hernia repair was done in 6 patien ts. Complications occurred in 11 patients; 6 had esophageal leaks. The re were three operative deaths (9.1%), all occurring in patients with abnormal manometry. Follow-up was complete in 29 patients and ranged f rom 4 months to 15 years (median, 6.9 years). Long-term results were e xcellent in 14 patients (48.2%), good in 8 (27.6%), fair in 5 (17.2%), and poor in 2 (6.9%). We conclude that operation has significant risk s and is not warranted in patients with minimal symptoms because progr ession is unlikely. Surgical treatment, however, is advisable in patie nts with incapacitating symptoms because most operative survivors will have long-term symptomatic palliation.