The Abdominal Approach for Epiphrenic Esophageal Diverticulum as an Alternative to the Thoracic Approach / 대한흉부외과학회지

BACKGROUND: There is no established surgical procedure for the treatment of epiphrenic esophageal diverticulum. The aim of this study was to compare the clinical outcomes of esophageal diverticulectomy using abdominal and thoracic approaches. METHODS: We retrospectively reviewed 30 patients who underwent esophageal diverticulectomy through the thoracic or abdominal approach for an epiphrenic diverticulum at a single center between 1996 and 2018. We compared clinical outcomes, including the postoperative length of stay, time from the operation to oral feeding, leakage rate, and reoperation rate between the 2 groups. RESULTS: The median age was 56 years. Of the 30 patients, 18 (60%) underwent diverticulectomy via the thoracic approach and 12 (40%) underwent the abdominal approach. The median hospital stay was 10 days (range, 5–211 days) in the thoracic approach group and 9.5 days (range, 5–18 days) in the abdominal approach group. The median time from the operation until oral feeding was 6.5 days (range, 3–299 days) when the thoracic approach was used and 5 days (range, 1–11 days) when the abdominal approach was used. In the thoracic approach group, the leakage rate was 16.67% and the reoperation rate was 27.78%. However, there were no cases of leakage or reoperation in the abdominal approach group. CONCLUSION: The abdominal approach for esophageal diverticulectomy is a feasible and appropriate alternative to the thoracic approach.

Massive bleeding in epiphrenic esophageal diverticulum: A case report.

Esophageal diverticulum is an outpouching of the esophageal wall. Approximately 65% of diverticulum is asymptomatic. Although bleeding from esophageal diverticulum is a rare symptom, it is a life-threatening complication. The authors report a 45-year-old man with massive upper gastrointestinal bleeding and hypovolemic shock. Esophago-gastro-duodenoscopic examination revealed bleeding from a large epiphrenic esophageal diverticulum. The bleeding point was stopped by endoscopic adrenaline injection therapy. Radiographic examination revealed two esophageal diverticula. The larger one, a wide-mouth diverticulum of the epiphrenic type, was the cause of bleeding. An esophageal diverticulectomy with cardiomyotomy was performed via video-assisted thoracoscopic surgery (VATS). There was no esophageal leakage or post-operative morbidity or mortality. The patient had no recurrent bleeding during 24 months after operation.