Surgical treatment of epiphrenic diverticula: a 30-year experience

Epiphrenic diverticula are rare and associated with esophageal motility abnormalities. Their optimal surgical treatment is debated, mortality being 9% in the largest reported surgical series of 33 patients. Our experience with a traditional thoracic approach was reviewed to provide benchmark data against which newer surgical techniques can be measured.

A retrospective review of 35 patients operated on for epiphrenic diverticula from 1976 to 2005 was conducted. All underwent open transthoracic operations: resection of the diverticulum, long esophagomyotomy, and antireflux operations (modified Belsey, 29 patients; Nissen, 4 patients) in 33 patients; resection and long myotomy alone in 1 patient; and plication, long myotomy, and Collis-Nissen in 1 patient. Preoperative assessment included barium esophagogram, flexible esophagoscopy, manometry, and standard acid reflux test. Operative complications and functional results were assessed.

Median age was 71 years (range, 36 to 87 years). Diverticulum size averaged 6.4 cm (range, 3 to 14 cm). Sixty-eight percent presented to the right of the esophagus. The median duration of symptoms was 3 years. Presenting complaints included dysphagia (83%), regurgitation (69%), and chest pain (26%). Eighteen had a mean weight loss of 19 pounds. There was 1 perioperative death (2.8%) from a plicated diverticulum leak and one nonfatal suture line leak. Median hospital stay was 7 days. Mean follow-up was 45.3 months. Twenty-six patients (74%) had an excellent result (no residual symptoms). Seven required a periodic esophageal dilatation for intermittent mild dysphagia.

Traditional transthoracic resection, long esophagomyotomy, and an antireflux procedure provide excellent long-term functional results with relatively low postoperative morbidity in patients with epiphrenic diverticula.