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Herbella et al. Mini-invasive Surg 2020;4:82 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.84

Technical Note Open Access

Minimizing complications after minimally invasive
surgery for epiphrenic diverticula of the esophagus:

technical tips

Fernando A. M. Herbella , Marco G. Patti 2
1
1 Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP 04037-003, Brazil.
2 Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

Correspondence to: Dr. Fernando A. M. Herbella, Department of Surgery, Escola Paulista de Medicina, Federal University of São
Paulo, Rua Diogo de Faria 1087 cj 301, São Paulo, SP 04037-003, Brazil. E-mail: herbella.dcir@epm.br

How to cite this article: Herbella FAM, Patti MG. Minimizing complications after minimally invasive surgery for epiphrenic
diverticula of the esophagus: technical tips. Mini-invasive Surg 2020;4:82. http://dx.doi.org/10.20517/2574-1225.2020.84

Received: 19 Aug 2020 First Decision: 16 Sep 2020 Revised: 16 Sep 2020 Accepted: 19 Oct 2020 Published: 6 Nov 2020
Academic Editor: Uberto Fumagalli Romario Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Epiphrenic diverticula occur within the distal 10 cm of the esophagus. Because they are secondary to an underlying
esophageal motility disorder, the surgical treatment of these diverticula must include a myotomy in addition to the
resection of the diverticulum. In selected cases, the diverticulum can be left in place, performing only the myotomy
and the partial fundoplication. Most patients will eventually become asymptomatic and the diverticulum can be
left in place. Overall, it is a challenging operation that may be associated to significant morbidity. In this review, we
illustrate the key technical elements and how to troubleshoot eventual problems.

Keywords: Esophageal epiphrenic diverticulum, high resolution manometry, esophageal motility disorders,
achalasia, diverticulectomy, esophageal myotomy

INTRODUCTION
Esophageal diverticula are an uncommon disorder with an incidence less than 4% in endoscopic
[1]
and radiologic series . They are located above the sphincters that delimit the esophagus (epiphrenic
diverticulum for the lower esophageal sphincter and Zenker’s diverticulum for the upper esophageal
sphincter) and are secondary to dysfunction of these sphincters. This leads to increased pressure and
herniation of the mucosa through gaps in the muscular layer (pulsion pseudodiverticulum) or in the

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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