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Ann Thorac Surg 2007;84:1801-1809. doi:10.1016/j.athoracsur.2007.06.057
© 2007 The Society of Thoracic Surgeons
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Thomas K. Varghese, Jr
Becky Marshall
Andrew C. Chang
Allan Pickens
Christine L. Lau
Mark B. Orringer
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Hawley H. Seiler Resident Award Paper

Surgical Treatment of Epiphrenic Diverticula: A 30-Year Experience

Thomas K. Varghese, Jr, MD*, Becky Marshall, Andrew C. Chang, MD, Allan Pickens, MD, Christine L. Lau, MD, Mark B. Orringer, MD*

Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan

Accepted for publication June 13, 2007.

* Address correspondence to Dr Orringer, Section of Thoracic Surgery, University of Michigan, 1500 E Medical Center Dr, 2120 Taubman Center, Box 0344, Ann Arbor, MI 48109-0344 (Email: morrin{at}umich.edu).

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.






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