title: Thoracic Esophageal Diverticula: A 15-Year Experience of Minimally Invasive Surgical Management.
abstract: BACKGROUND
  Thoracic esophageal diverticula are uncommon, and controversies exist regarding their management. The objective of this study was to evaluate the outcomes of a relatively large cohort of patients with thoracic esophageal diverticula treated with minimally invasive surgical techniques.
  
  
  METHODS
  We conducted a retrospective review of patients who underwent minimally invasive surgical treatment for symptomatic esophageal diverticula during a 15-year period. The primary end point was 30-day mortality. In addition, we evaluated the morbidity, improvement in dysphagia (score: 1, best to 5, worst), and quality of life (Gastroesophageal Reflux Disease-Health-Related Quality of Life score: 0, best to 50, most symptoms).
  
  
  RESULTS
  Fifty-seven patients underwent minimally invasive surgical treatment of symptomatic thoracic esophageal diverticula. The most common symptom was dysphagia (45 of 57; 79%). A motility disorder or distal mechanical obstruction was identified in 49 patients (86%). Approaches used included video-assisted thoracoscopic surgery (n = 33), laparoscopy (n = 18), and combined video-assisted thoracoscopic surgery and laparoscopy (n = 6). The most common procedure performed was diverticulectomy and myotomy (47 of 57 patients; 82.5%). The 30-day mortality was 0%. There were 4 patients (7%) with postoperative leaks requiring reoperation. During follow-up, the median dysphagia score improved from 3 to 1 (p < 0.001). The median Gastroesophageal Reflux Disease-Health-Related Quality of Life score after surgery was 5 (excellent).
  
  
  CONCLUSIONS
  A minimally invasive surgical approach for the management of thoracic esophageal diverticula is safe and effective during intermediate-term follow-up when performed by surgeons experienced in esophageal surgery and minimally invasive techniques. Further follow-up is required to assess the durability of these results. The optimal approach and procedures performed should be determined on an individualized basis after a thorough investigation.
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Macke
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: pennathura@upmc.edu.
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Valentino
authors.initials: V
authors.lastname: Bianco
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Omar
authors.initials: O
authors.lastname: Awais
authors.affiliation: Department of Biostatistics, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: William E
authors.initials: WE
authors.lastname: Gooding
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Katie S
authors.initials: KS
authors.lastname: Nason
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Levy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004936:Diverticulum, Esophageal / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013909:Thorax; D013997:Time Factors; D016896:Treatment Outcome