[Epiphrenic diverticulum: possible causes and surgical therapy].
BACKGROUND
In the majority of patients suffering from epiphrenic diverticula, functional disorders of the esophagus are evident. The significance of surgical therapy is unclear, especially in case of nonspecific esophageal motility disorders. Besides "triple therapy" with diverticulectomy, myotomy, and semifundoplication, myotomy alone is also applied. Based on our own long-term results, we intended to prove if a treatment concept modeled on the motility disorder is justified.


METHODS
Between July 1989 and December 2002, 12 patients with symptomatic epiphrenic diverticula underwent surgery at our clinic. Myotomy was carried out with diverticulectomy (and semifundoplication) only if achalasia had been proven, and an antireflux procedure was done only in case of gastroesophageal reflux. Surgery was performed openly in ten patients, and laparoscopically in two.


RESULTS
After a median follow-up of 46 months (range 9-169), all patients regarded the operative results as good to very good (11 follow-up investigations).


CONCLUSIONS
To alleviate symptoms in patients with epiphrenic diverticula, myotomy is only rarely indicated. As with diverticulectomy, it is only necessary, if achalasia has been proven. Our long-term results do not suggest performing myotomy as a rule for underlying unspecific motility disorders of the esophagus.
Gockel
I
I
Klinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität Mainz. gockel@ach.klinik.uni-mainz.de
Eckardt
V F
VF
Junginger
T
T
D000368:Aged; D004936:Diverticulum, Esophageal / Q000209:etiology / Q000601:surgery*; D015154:Esophageal Motility Disorders / Q000209:etiology / Q000601:surgery*; D004944:Esophagoplasty; D005260:Female; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013528:Surgical Staplers; D013536:Suture Techniques; D013908:Thoracotomy; D016896:Treatment Outcome