Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

INTRODUCTION Mid and distal esophageal (epiphrenic) diverticula are rare. Historically, treated by resection with myotomy via thoracotomy surgical management was associated with significant length of stay (LOS), morbidity and mortality. This study documents the diagnosis, minimally invasive treatment, and follow-up of an 11 year experience. METHODSUsing an IRB-approved database, patients with mid and distal esophageal diverticula that underwent minimally invasive treatment were identified. Data analyzed include demographics, symptoms, diagnosis, diverticular size, surgery performed, and postoperative complications. The data was reported as the mean + standard deviation.RESULTSSixteen patients were identified (10 female, 6 male); mean age was 62 years (range 38 - 75). The duration of symptoms averaged 101 months (range 2 to 720 months). All patients were symptomatic, including dysphagia (n=16), regurgitation (n=11), and reflux (n-7). All patients had pre-operative esophagram, manometry and an EGD. 12 of 16 patients had an esophageal motility disorder achalasia being the most common (n=9). One patient had a failed Nissen fundoplication with the development of a diverticulum. There were 3 mid esophageal and 13 epiphrenic diverticula. Mean size was 7.3 cm. Fifteen underwent laparoscopic and one underwent thoracoscopic diverticulectomy, myotomy and fundoplications. There were no conversions to open. One complication occurred, pneumonia and there were no deaths. Estimated blood loss was 111 cc. Mean LOS was 6.8 days (range 2-33) with no esophageal leaks with a mean follow-up of 13 months (range 2-86 months). One patient reports residual dysphagia, substantially improved from pre-op.CONCLUSIONMid and distal esophageal diverticula are most often associated with a motility disorder. Although they are rare, they can be symptomatic in patients. Minimally invasive techniques provide adequate treatment for even large diverticula with limited post-operative complications and excellent symptom resolution.