title: Laparoscopic treatment of epiphrenic diverticula.
abstract: OBJECTIVE
  Epiphrenic diverticula are a rare disease probably caused by long-standing impairment of esophageal motor activity. Symptomatic disease, which may worsen clinically during follow-up even to severe symptoms, is usually considered an indication for surgical treatment. Surgery for epiphrenic diverticula consists of diverticulectomy, which traditionally is performed through a left thoracotomy; a myotomy and partial fundoplication are generally included in order to treat the underlying motor disorder and to prevent or correct reflux. The same principles of surgical treatment can be achieved through the laparoscopic transhiatal approach. The aim of this paper is to describe the technique and the results of laparoscopic diverticulectomy combined with esophageal myotomy and antireflux wrap to treat epiphrenic diverticula of the esophagus.
  
  
  METHODS
  From January 1994 through May 2001, 11 patients underwent laparoscopic transhiatal diverticulectomy, esophageal myotomy, and partial fundoplication at our institution.
  
  
  RESULTS
  In all patients, the operation was completed through the minimally invasive access. The postoperative course was complicated in one patient (9%), who had a leak from the staple line, which was repaired through a thoracotomy. At follow-up, this patient had persistence of a small pouch at the diverticuletomy site. However, he was asymptomatic. All other patients were free of symptoms and without recurrence.
  
  
  CONCLUSIONS
  Laparoscopy offers good access to the distal esophagus and the inferior mediastinum. Removal of the diverticulum, treatment of the motor disorder, and prevention of postoperative reflux can all be obtained through this approach. The immediate postoperative and long-term results are satisfactory.
authors.affiliation: General and Minimally Invasive Surgery, Istituto Clinico Humanitas, Milan, Italy. riccardo.rosati@humanitas.it
authors.forename: R
authors.initials: R
authors.lastname: Rosati
authors.forename: U
authors.initials: U
authors.lastname: Fumagalli
authors.forename: S
authors.initials: S
authors.lastname: Bona
authors.forename: M
authors.initials: M
authors.lastname: Zago
authors.forename: S
authors.initials: S
authors.lastname: Celotti
authors.forename: P
authors.initials: P
authors.lastname: Bisagni
authors.forename: A
authors.initials: A
authors.lastname: Peracchia
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures; D004936:Diverticulum, Esophageal / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged