Long-term results of minimally invasive surgery for symptomatic epiphrenic diverticulum

BACKGROUND: the real incidence of epiphrenic diverticulum is unknown, and only 15% to 20% of cases are symptomatic. METHODS: from january 1994 to May 2009, 20 patients were treated laparoscopically for this condition. RESULTS: the most common operation performed was transhiatal diverticulectomy with myotomy and partial fundoplication. No case was converted to open surgery. Esophageal leak occurred in 1 patient (5%). The postoperative courses were uneventful in the remaining 19 patients. After a median follow-up period of 52 months (range, 1-141 months), 1 patient had died of squamous cell carcinoma, 1 had mild solid-food dysphagia, 1 had chest pain, and 1 had heartburn. Manometry was performed postoperatively in 7 patients; all had normal lower esophageal sphincter pressure. In 5 patients who underwent 24-hour postoperative pH monitoring, pathologic reflux was absent. CONCLUSIONS: in patients with symptomatic epiphrenic diverticulum, laparoscopic surgery is feasible, providing good access to the distal esophagus and inferior mediastinum. Long-term outcomes are satisfactory.