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Tailored surgery for esophageal body diverticula
G Castrucci1, V Porziella, P L Granone
1Department of Surgery I, A. Gemelli Medical School, Catholic University of Rome, Italy. icpsc@unicatt.rm.it
Summary
Esophageal body diverticula are often linked to functional disorders like dysmotility or gastro-esophageal reflux (GER). Tailored surgery addressing these underlying issues, not just diverticulectomy, yields the best patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Esophageal Diseases
Background:
- Esophageal body diverticula can be associated with underlying functional gastrointestinal disorders.
- Accurate diagnosis of these disorders is crucial for effective patient management.
Purpose of the Study:
- To identify associated functional disorders (dysmotility, GER) in patients with esophageal body diverticula.
- To guide patient selection for surgery and plan tailored treatment strategies.
- To evaluate the efficacy of tailored surgical interventions.
Main Methods:
- Functional evaluation of 51 patients with esophageal body diverticula using radiology, endoscopy, and manometry.
- 24-hour pH-monitoring for patients with suspected GER.
- Treatment planning based on diverticulum excision, correction of esophageal dysmotility, LES dysfunction, or GER.
Main Results:
- Esophageal motor dysfunction detected in 73% of patients; impaired LES function in 53%.
- Gastro-esophageal reflux (GER) identified in 9 of 11 tested patients.
- 96% of patients had associated dysmotility or GER; 27 underwent tailored surgery with an 11% complication rate and 7% mortality.
- 92% satisfactory results at a mean follow-up of 47 months.
Conclusions:
- Esophageal body diverticula frequently present with underlying functional disorders.
- A comprehensive physiopathological evaluation is essential for all patients.
- Tailored surgical treatment focusing on the primary functional disorder, not solely diverticulectomy, leads to optimal outcomes.