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Updated: Jun 24, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
[Epiphrenic diverticula: when and how to operate?]
David Ruiz De Angulo Martín1, M Angeles Ortiz Escandell, Luisa F Martínez De Haro
1Unidad de Cirugía Esofágica, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España. druizdeangulo@hotmail.com
Abstract:
The majority of epiphrenic diverticula arise due to a peristaltic mechanism caused by an oesophageal motor disturbance that establishes a barrier effect and causes mucosal and submucosal herniation through a weak point in the muscular layer. Intraluminal oesophageal manometry and video-radiology are important in assessing these patients, since they define the characteristics of the functional disorder, as well as the true relationship between the symptoms of the patient and the diverticulum. Surgical treatment is indicated in symptomatic patients, more so if there are respiratory complications. Left posterolateral thoracotomy followed by diverticulotomy, oesophageal cardiomyotomy and anti-reflux have been considered the surgery technique of choice. Oesophageal myotomy must go beyond, in a proximal direction, the neck of the diverticulum, and, in a distal direction, must progress 1-2 cm into the gastric wall. The laparoscopic approach has won many followers since it has been shown to be both safe and effective as open surgery, adding to the advantages of minimally invasive surgery.
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