Alison E Brandeis, BA, MS, Saurabh Singhal, MBBS, Sumeet K MIttal, MBBS. Creighton University School of Medicine
Epiphrenic diverticulum is a rare esophageal disorder. Delay in diagnosis is common and it is often clinically confused with and treated as gastro-esophageal reflux. We present our single center experience of surgical management for epiphrenic diverticulum over a 12-year period.
After IRB approval, a prospectively maintained database was queried to identify patients who underwent surgical intervention for primary epiphrenic diverticulum. Patients were reviewed for preoperative and postoperative symptoms, operative data, perioperative complications and long-term follow-up.
Twenty-seven patients (15 females) underwent surgery for epiphrenic diverticulum from January 2004 to April 2016. Mean age of presentation was 66 (35-90) years. Most common primary presenting symptoms were dysphagia (52%) and regurgitation (30%). Median duration of symptoms at presentation was 2 years (3 months–21 years). Common secondary presenting symptoms were dysphagia, regurgitation, heartburn and odynophagia.
Twenty-one procedures were done laparoscopically, with one conversion to open. Five procedures were done transthoracically (1 right thoracotomy, 3 left thoracotomies and 1 left thoracoscopy). One procedure was completed by combined thoracotomy and laparoscopy. Mean distance of the diverticulum base to the GEJ was 4.0 cm (0.5-8 cm). All patients had diverticulectomy with 2.5mm staple with a 44 or 46 French bougie in situ. Twenty-six had surgical myotomy from 1 cm above the diverticulum to 1-2 cm below the GEJ. Mean length of myotomy was 8.5 cm (4-12 cm). Twenty-three (85%) received concurrent partial fundoplication. Complications included vagal injury (4), perforation of diverticulum (1); esophagus (2) or stomach (1) and torn crus (1); all managed intra-operatively. Single conversion was due to a left liver lobe mass which was resected. There was no intraoperative mortality. Median hospital stay was 5 days (2-33 days). Postoperative morbidity of Clavien-Dindo grade III or more was seen in 2 patients (7.4%). One staple-line leak was managed with endoscopic washes and stent placement postoperatively. A single bilateral pleural effusion was managed with chest drainage.
Follow up data was available for 26 (96%) with mean follow up of 2.0 years (2 weeks – 12.3 years). Most common follow-up symptoms were abdominal bloating (30%), heartburn (22%), regurgitation (11%) and dysphagia (7%). Subjective satisfaction at follow-up was available for 16, with 14 rating satisfaction as excellent (88%), one as good and one as unsatisfactory. Of these, 15 (94%) would recommend the procedure to a friend.
Surgical correction for epiphrenic diverticulum is safe and is associated with low morbidity and high satisfaction rate, most can be done laparoscopically.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78172
Program Number: S145
Presentation Session: Foregut 3
Presentation Type: Podium