title: Minimally invasive therapy for epiphrenic diverticula: Systematic review of literature and report of six cases.
abstract: BACKGROUND
  Epiphrenic diverticula (ED) are infrequent and conventional surgical treatment entails aggressive open or transthoracic surgery. Minimally invasive treatment has changed the surgical approach but some surgical controversies are not resolved.
  
  
  OBJECTIVE
  The objective of this study is to describe our experience in minimally invasive treatment of the ED and to perform a systematic review of the current literature in this subject.
  
  
  METHODS
  We reviewed all data from the Hospital de Sant Pau, focusing on patients that underwent minimally invasive treatment for an ED since 1998 to date. Furthermore, we performed a systematic literature review focused on the minimally invasive approach for ED.
  
  
  RESULTS
  A total of 6 patients have been treated (5 transhiatal and 1 with abdominal and thoracic approach). We found a predominance of males with a median age of 63. The diagnosis was made with an endoscopy, barium swallow and manometry. Half of the manometry results were pathologic. The surgical technique involved a diverticulectomy, myotomy and a Dor partial founduplication. Two patients that presented suture line leakage (SLL) were treated conservatively. No mortality was reported. The systematic review was carried out under the Preferred Reporting Items for Systematic Reviews and Meta-analyses scheme, with a total of 20 studies where 189 patients were found. No comparative or prospective randomised trials were found. Overall morbidity was 24%, with a SLL rate of 12%, hospital stay of 5 days and mortality of 1.5%. After a median follow-up of 42 months, 81.5% of the patients were asymptomatic.
  
  
  CONCLUSIONS
  The minimally invasive approach for ED is a safe and feasible procedure.
authors.affiliation: Deparment of General Surgery, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain.
authors.forename: Mariel
authors.initials: M
authors.lastname: Gonzalez-Calatayud
authors.affiliation: Deparment of General Surgery, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain.
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Targarona
authors.affiliation: Deparment of General Surgery, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Balague
authors.affiliation: Deparment of General Surgery, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez-Luppi
authors.affiliation: Deparment of General Surgery, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain.
authors.forename: Ana B
authors.initials: AB
authors.lastname: Martin
authors.affiliation: Deparment of General Surgery, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Trias
keywords: Epiphrenic diverticula; minimally invasive surgery; oesophageal diverticulum