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

Abstract

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.

Minimizing complications after minimally invasive surgery for epiphrenic diverticula of the esophagus: technical tips

“…When outcomes are compared, disease recurrence is rare for both approaches [8] and the results seem to be similar for thoracoscopy and laparoscopy [8,[12][13][14] . If diverticulectomy is considered important (due to symptoms) after a laparoscopic myotomy and partial fundoplication, a thoracoscopic diverticulectomy is safer.…”

“…A recent systematic review and meta-analysis with 511 patients [14] showed that the diverticulum was left in situ in only 7% of the cases, mostly due to small size. Castrucci et al [18] also did not perform a diverticulectomy in the presence of wide-necked diverticula without food retention in the pouch, pulmonary aspiration, or mucosal lesions.…”

Diverticulo De Esofago Médio: Relato De Caso

“…Estão associados a doenças crônicas do mediastino. Os divertículos de pulsão são divertículos falsos, portanto, contendo apenas túnicas mucosas e telas submucosas, causados pelo aumento da pressão intraluminal, secundária a um distúrbio de motilidade ou obstrução mecânica (3).…”

Epiphrenic Diverticula. "Primum Non Nocere" (First Do Not Harm)

“…As a consequence of these difficulties the probability of having a leak from the suture line is pretty high, slightly above 20%, as pointed out by two recent systematic reviews (24,25).…”

“…The importance of the myotomy as a fundamental part of the treatment for epiphrenic diverticula was clearly illustrated in a series of 21 patients published by the Mayo Clinic: patients treated with diverticulectomy alone suffered from higher leakage and recurrence rates (24% and 19%, respectively) than those who had diverticulectomy with a myotomy (0% for both leakage and recurrence rates) (26). In a recent systematic review of 25 observational studies on 511 patients Chang et al reported a lower rate of anastomotic leak when a myotomy was added form 26.1% (without myotomy) to 12.4% (with myotomy) (24).…”