Laparoscopy as the initial approach for epiphrenic diverticula

Soares, Ronaldo Viana; Montenovo, Martin I.; Oelschlager, Brant K.

doi:10.1007/s00464-011-1779-x

Cited by 42 publications

(42 citation statements)

References 25 publications

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“…Seven studies utilised the thoracoscopic approach6 , 12 , 13 , 26 – 29 in 42 patients. Seven studies utilised laparoscopy alone11 , 30 – 35 in 204 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Selective and routine approaches to myotomy were adopted in 156 – 8 , 10 , 13 , 19 , 21 – 26 , 28 , 29 , 31 and 1011 , 12 , 18 , 20 , 27 , 30 , 32 – 35 studies, respectively. Myotomy was performed on the contralateral and ipsilateral sides to the diverticulectomy in 11 studies7 , 10 , 18 – 21 , 23 , 24 , 27 , 32 , 33 ( n = 237) and 1 study,30 respectively ( n = 21) and on either side in 1 study26 ( n = 47) and anteriorly in 12 studies6 , 8 , 11 – 13 , 22 , 25 , 28 , 29 , 31 , 34 , 35 ( n = 132).…”

Section: Resultsmentioning

confidence: 99%

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Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker’s Oesophageal Diverticula

Chan

Foliaki

Lewis

et al. 2017

Journal of Gastrointestinal Surgery

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BackgroundOesophageal diverticula are rare outpouchings of the oesophagus which may be classified anatomically as pharyngeal (Zenker’s), mid-oesophageal and epiphrenic. While surgery is indicated for symptomatic patients, no consensus exists regarding the optimum technique for non-Zenker’s oesophageal diverticula. The aim of this study was to determine the outcome of surgery in patients with non-Zenker’s oesophageal diverticula.MethodsPubMed, MEDLINE and the Cochrane Library (January 1990 to January 2016) were searched for studies which reported outcomes of surgery in patients with non-Zenker’s oesophageal diverticula. Primary outcome measure was the rate of staple line leakage.ResultsTwenty-five observational studies involving 511 patients (259 male, median age 62 years) with mid-oesophageal (n = 53) and epiphrenic oesophageal (n = 458) diverticula who had undergone surgery [thoracotomy (n = 252), laparoscopy (n = 204), thoracoscopy (n = 42), laparotomy (n = 5), combined laparoscopy and thoracoscopy (n = 8)] were analysed. Myotomy was performed in 437 patients (85.5%), and anti-reflux procedures were performed in 342 patients (69.5%). Overall pooled staple line leak rates were reported in 13.3% [95% c.i. (11.0–15.7), p < 0.001] and were less common after myotomy (12.4%) compared with no myotomy (26.1%, p = 0.002).ConclusionsNo consensus exists regarding the surgical treatment of non-Zenker’s oesophageal diverticula, but staple line leakage is common and is reduced significantly by myotomy.

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“…Seven studies utilised the thoracoscopic approach6 , 12 , 13 , 26 – 29 in 42 patients. Seven studies utilised laparoscopy alone11 , 30 – 35 in 204 patients.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker’s Oesophageal Diverticula

Chan

Foliaki

Lewis

et al. 2017

Journal of Gastrointestinal Surgery

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“…[3,17] It appears that the advantages of the minimally invasive approach include: easy access, improved visualization, proper stapling line, possibility of myotomy and antirefl ux technique, along with the possibility of treating any complication during the surgery. In addition, there is a shorter hospital stay and minimal analgesia requirements.…”

Section: Discussionmentioning

confidence: 99%

“…Myotomy: 90% of the authors performed myotomyin a total of 170 patients, 61% extended to stomach between 1 and 2 cm, but Soares [17] did the myotomy only in the diverticular neck with 5.2% leakage rate (Table 2).…”

Section: Preoperative Characteristicsmentioning

confidence: 99%

“…[10][11][12][13] Nowadays, there is no consensus on the type of surgical access, the length of the myotomy or the type of antirefl ux technique. [1,7,14,[16][17][18][19][20][21] The conventional surgical procedure that was usually performed consisted a left thoracotomy, di-verticulectomy, myotomy and a Belsey Mark IV procedure, nonetheless, this treatment implicates a non-negligible morbidity rate reaching up to 20-25% of patients, the most important one being suture line leakage and a mortality up 5%. [22] These results and the good access to the hiatal hiatus obtained through a minimally invasive technique has favoured during last years to switch to endoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive therapy of epiphrenic diverticula: Systematic review of the literature and report of 6 cases

Calatayud¹

2017

Laparosc Endosc Surg Sci

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Epiphrenic diverticula is an uncommon disease, and conventional surgical treatment entails aggressive open or transthoracic surgery. Minimally invasive treatment has changed the surgical approach, but a number of surgical controversies remain unresolved. The present study is a description of our experience with minimally invasive treatment of epiphrenic diverticula and a systematic review of the current literature on this subject. All data from the Hospital de Sant Pau were reviewed to identify patients who underwent minimally invasive treatment for epiphrenic diverticulum since 1998. In addition, systematic literature review focused on minimally invasive approach for epiphrenic diverticula was performed. Total of 6 patients have been treated (6 transhiatal and 1 with abdominal and thoracic approach) at the hospital. Predominance of male patients was observed, with median age of 63 years. Diagnosis was made with endoscopy, barium swallow, or manometry. Half of manometry results where pathological. Surgical techniques applied were diverticulectomy, myotomy, and Dor partial fundoplication. Two patients with suture line leakage were treated conservatively. No mortality was reported. Systematic literature review was conducted using the PRISMA scheme, and 21 studies with 189 patients were found. No comparative or prospective randomized trials were located. Overall morbidity rate was 24%, suture line leakage rate was 12%, hospital stay was 5 days, and mortality rate of 1.5% in the literature. After median follow up of 42 months, 81.5% of the patients were asymptomatic. Minimally invasive approach for epiphrenic diverticula is a safe and feasible procedure.

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Treatment of Epiphrenic Diverticula

Fisichella

Hiranyatheb

Ferguson

2013

Surgical Management of Benign Esophageal Disorders

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Laparoscopy as the initial approach for epiphrenic diverticula

Abstract: Most epiphrenic diverticula can be treated successfully by using a laparoscopic approach. Morbidity and conversion rates are low and symptom control is excellent.

Cited by 42 publications

References 25 publications

Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker’s Oesophageal Diverticula

Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker’s Oesophageal Diverticula

Minimally invasive therapy of epiphrenic diverticula: Systematic review of the literature and report of 6 cases

Treatment of Epiphrenic Diverticula

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