• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / A Thoracoscopic and/or Laparoscopic Approach To Epiphrenic Diverticula Is An Alternative to Thoracotomy

A Thoracoscopic and/or Laparoscopic Approach To Epiphrenic Diverticula Is An Alternative to Thoracotomy

Virginie Achim, MD, Ralph W Aye, MD, Brian Louie, MD, Alex Farivar, MD. Swedish Medical Center, Division of Thoracic and Esophageal Surgery

Introduction

The traditional approach to epiphrenic diverticula is thoracotomy, diverticulectomy, and myotomy to address dysmotility with/without partial fundoplication. A laparoscopic approach has been advocated but access to higher diverticula is problematic. We hypothesized a thoracoscopic and/or laparoscopic approach may overcome these challenges and sought to review our results.

Methods and Procedures

A retrospective review from 2004 to 2013 identified 13 patients with an epiphrenic diverticulum who underwent surgery. Patients were grouped according to height of the diverticular neck above the GEJ: group A < 5 cm, group B > 5 cm. Preoperative studies including EGD, manometry, and UGI, presenting symptoms, location and size of the diverticulum, as well as type of surgery performed were recorded. Post-operative complications, mortality, and clinical outcomes using quality of life metrics (QOLRAD, GERD-HRQL and Eckardt score) and objective testing were assessed. Mean follow up was 19 months.

Results

A motility disorder was identified in 11/13. The mean size of the diverticulum was 2.7 cm (2-4 cm); and the mean height above the GEJ was 5 cm (0-12 cm); there were 7 (54%) in group A and 6(46%) in group B.

Group A patients underwent laparoscopic diverticulectomy, myotomy and partial fundoplication. The intended procedure in group B was thoracoscopic diverticulectomy followed by laparoscopic myotomy and partial fundoplication. This was completed in 3 but myotomy was compromised in 3 due to prior myotomy and adhesions, and bleeding from platelet inhibition. All 3 had staple line leaks resulting in 1 death. At a mean follow of 19 months, the median QOLRAD scores improved from 3.29 to 5.97; GERD-HRQL improved from 22.5 to 13.5, and Eckardt scores improved from 6.14 to 1.5.

Conclusions

A minimally invasive strategy for epiphrenic diverticula based on location of the diverticulum above the GEJ and utilizing selective thoracoscopy for higher diverticula was successful and resulted in improved quality of life. Incomplete myotomy was associated with a substantially higher failure.

96

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals