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Related Concept Videos

Esophageal Achalasia01:27

Esophageal Achalasia

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Esophageal achalasia is a chronic neurogenic disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent or ineffective peristalsis in the distal esophagus. This leads to a functional obstruction without a physical blockage, despite significant disruption of esophageal motility.EtiologyAchalasia is caused by degeneration of the myenteric (Auerbach's) plexus, specifically the loss of inhibitory ganglion cells that produce vasoactive intestinal peptide...
3
Hiatal Hernia01:25

Hiatal Hernia

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A hiatal hernia is the abnormal protrusion of the stomach or other abdominal organs through the esophageal hiatus of the diaphragm into the thoracic cavity.Normally, the gastroesophageal junction (GEJ) lies below the diaphragm and is supported by the phrenoesophageal membrane, the diaphragmatic crura, and connective tissues. Weakening of these structures—due to aging, congenital defects like a short esophagus, or increased intra-abdominal pressure from coughing, obesity, pregnancy, or...
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Diverticular Disease of the Colon01:27

Diverticular Disease of the Colon

2
Diverticular disease involves the formation of diverticula—small sac-like outpouchings of the colonic wall—and their complications. It most commonly affects the sigmoid colon due to higher intraluminal pressure and structural vulnerability. It results from structural weakness and increased pressure in the colon, producing pseudodiverticula that may remain silent or progress to inflammation and serious complications.Structure of DiverticulaIn diverticulosis, these outpouchings are...
2
Gastroesophageal Reflux Disease01:25

Gastroesophageal Reflux Disease

2
Gastroesophageal reflux disease (GERD) is the backward flow of stomach contents (acid, pepsin, or bile) into the esophagus, causing mucosal inflammation known as esophagitis. It results from failure of antireflux mechanisms, mainly the lower esophageal sphincter (LES), influenced by mechanical and physiological factors.Etiology and Risk FactorsGERD develops when LES function is weakened or when intra-abdominal pressure increases. Risk factors include aging, obesity, and sliding hiatal hernia,...
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Esophageal Strictures-II: Clinical Features and Management01:26

Esophageal Strictures-II: Clinical Features and Management

1.0K
Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
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Esophageal Strictures-I: Introduction01:30

Esophageal Strictures-I: Introduction

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Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
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Robotic Myotomy and Partial Fundoplication for Achalasia
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Achalasia and epiphrenic diverticulum.

Fernando A M Herbella1, Marco G Patti

  • 1Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003l, Brazil, herbella.dcir@epm.br.

World Journal of Surgery
|January 23, 2015
PubMed
Summary

Esophageal epiphrenic diverticulum (EED), often linked to achalasia, requires thorough preoperative evaluation. Laparoscopic Heller

Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Esophageal Diseases

Background:

  • Esophageal epiphrenic diverticulum (EED) is a pulsion-type pseudodiverticulum in the distal esophagus.
  • EED is frequently associated with achalasia, a motility disorder.
  • Symptom overlap between EED and achalasia necessitates careful differential diagnosis.

Purpose of the Study:

  • To outline the diagnostic and therapeutic strategies for esophageal epiphrenic diverticulum.
  • To emphasize the importance of preoperative evaluation in patients with EED and achalasia.

Main Methods:

  • Review of diagnostic modalities including endoscopy, esophagram, and esophageal manometry.
  • Discussion of surgical interventions for EED, focusing on laparoscopic Heller's myotomy and partial fundoplication.

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Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
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  • Consideration of adjunctive diverticulectomy for large diverticula.

    • Main Results:

    • Preoperative evaluation is crucial for patients with EED, similar to achalasia patients.
    • Endoscopy, esophagram, and manometry are essential for diagnosis and identifying motility disorders.
    • Laparoscopic Heller's myotomy with partial fundoplication is the preferred treatment for symptomatic EED.

    Conclusions:

    • Symptomatic EED, particularly when associated with achalasia, requires surgical intervention.
    • Diverticulectomy should be considered for large EEDs.
    • Endoscopic therapy for EED has limited documented experience.