title: Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker's Oesophageal Diverticula.
abstract: Oesophageal diverticula are rare outpouchings of the oesophagus which may be classified anatomically as pharyngeal (Zenker's), mid-oesophageal and epiphrenic. While surgery is indicated for symptomatic patients, no consensus exists regarding the optimum technique for non-Zenker's oesophageal diverticula. The aim of this study was to determine the outcome of surgery in patients with non-Zenker's oesophageal diverticula.
  
  
  
  PubMed, MEDLINE and the Cochrane Library (January 1990 to January 2016) were searched for studies which reported outcomes of surgery in patients with non-Zenker's oesophageal diverticula. Primary outcome measure was the rate of staple line leakage.
  
  
  
  Twenty-five observational studies involving 511 patients (259 male, median age 62 years) with mid-oesophageal (n = 53) and epiphrenic oesophageal (n = 458) diverticula who had undergone surgery [thoracotomy (n = 252), laparoscopy (n = 204), thoracoscopy (n = 42), laparotomy (n = 5), combined laparoscopy and thoracoscopy (n = 8)] were analysed. Myotomy was performed in 437 patients (85.5%), and anti-reflux procedures were performed in 342 patients (69.5%). Overall pooled staple line leak rates were reported in 13.3% [95% c.i. (11.0-15.7), p < 0.001] and were less common after myotomy (12.4%) compared with no myotomy (26.1%, p = 0.002).
  
  
  
  No consensus exists regarding the surgical treatment of non-Zenker's oesophageal diverticula, but staple line leakage is common and is reduced significantly by myotomy.
authors.affiliation: Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. dcsy23@gmail.com.
authors.forename: David S Y
authors.initials: DSY
authors.lastname: Chan
authors.affiliation: Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
authors.forename: Antonio
authors.initials: A
authors.lastname: Foliaki
authors.affiliation: Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
authors.forename: Wyn G
authors.initials: WG
authors.lastname: Lewis
authors.affiliation: Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
authors.forename: Geoffrey W B
authors.initials: GWB
authors.lastname: Clark
authors.affiliation: Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
authors.forename: Guy R J C
authors.initials: GRJC
authors.lastname: Blackshaw
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology*; D004936:Diverticulum, Esophageal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D000074433:Myotomy / Q000009:adverse effects; D064887:Observational Studies as Topic; D013906:Thoracoscopy / Q000009:adverse effects; D013908:Thoracotomy / Q000009:adverse effects
keywords: Myotomy; Oesophageal diverticula