Epiphrenic diverticula are a rare disease almost always associated with an underlying motility disorder of the esophagus, such as achalasia. Treatment of any underlying motility disorder must be included in the management of epiphrenic diverticula to prevent postoperative complications and recurrences. Therefore, the goal of this paper is to describe the pathophysiology, clinical presentation, and proper methods of diagnosis and treatment of patients with epiphrenic diverticula. In addition, we aim to provide an overview of the surgical management and discuss the indications for surgery and choice of surgical approach. In general, surgical intervention is favored for symptomatic patients and the optimal surgical approach depends on the size and location of the diverticulum. Surgery is not without seemingly high rates of morbidity when a myotomy is not performed together with the diverticulectomy, even in those with normal manometry. The risk of carcinoma is exceedingly rare and it is usually discovered at later stages; therefore, no surveillance programs have been established in asymptomatic patients with unresected diverticula.

Objective Historically, acute kidney injury (AKI) carried a deadly prognosis in the burn population. Our aim with this study was to provide a modern description of AKI in the burn population and to develop a prediction tool for identifying patients at risk for late AKI. Methods A large multi-institution database, the Glue Grant's trauma related database (TRDB), was used to characterize AKI in a cohort of critically ill burn patients. We defined AKI according to the RIFLE criteria and categorized AKI as early, late or progressive. We then used Classification and Regression Tree (CART) analysis to create a decision tree with data obtained from the first 48 hours of admission to predict which subset of patients would develop late AKI. We tested the accuracy of this decision tree in a separate, single-institution cohort of burn patients who met the same criteria for entry into the Glue Grant study Results Of the 220 total patients analyzed from the Glue Grant cohort, 49 (22.2%) developed early AKI, 39 (17.7%) developed late AKI, and 16 (7.2%) developed progressive AKI. The group with progressive AKI was statistically older, with more comorbidities, and with the worst survival when compared to those with early or late AKI. Using CART analysis, we developed a decision tree with an overall accuracy of 80% for the development of late AKI for the Glue Grant dataset. We then tested this decision tree on a smaller dataset from our own institution to validate this tool, and found it to be 73% accurate. Conclusions AKI is common in severe burns with notable differences between early, late, and progressive AKI. Additionally, CART analysis provided a predictive model for early identification of patients at highest risk for developing late AKI with proven clinical accuracy.

Concomitant magnetic sphincter augmentation and hiatal hernia repair in patients with gastroesophageal reflux disease and a moderate-sized hiatal hernia demonstrates durable subjective reflux control and an acceptable hiatal hernia recurrence rate at 1- to 2-year follow-up.

The goal of this review is to illustrate our approach to patients with achalasia in terms of preoperative evaluation and surgical technique. Indications, patient selection and management are herein discussed. Specifically, we illustrate the pathogenetic theories and diagnostic algorithm with current up-to-date techniques to diagnose achalasia and its manometric variants. Finally, we focus on the therapeutic approaches available today: medical and surgical. A special emphasis is given on the surgical treatment of achalasia and we provide the reader with a detailed description of our pre and postoperative management.

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