Management of esophageal diverticula through an open surgical approach: A 16 year experience

Introduction: Esophageal diverticula are rare. There are controversies over the indication for surgery and the optimal surgical approach in these patients. In this study, we target to evaluate the complications and outcomes of 34 surgery candidates with esophageal diverticula undergoing an open approach.

Method: This is a retrospective review of patients with either cervical or thoracic diverticula who underwent surgery by thoracic surgery teams over a 16-year period. The selected surgical approach was postero-lateral thoracotomy for mid-esophageal and epiphrenic diverticula and left side neck incision for cervical esophageal diverticula. Myotomy was performed only in the case of esophageal motility disorders in patients with thoracic diverticula and in all patients with cervical diverticula. The postoperative intermediate-term outcomes were assessed.

Results: Of the 34 patients, 9 patients had cervical diverticula, 13 (38%) had mid-esophageal diverticula and 12 (35%) of those had epiphrenic diverticula. All the patients with epiphrenic and mid-esophageal diverticula underwent postero-lateral thoracotomy, and those with cervical esophageal diverticula underwent cervical approach. 21 patients underwent diverticulectomy and myotomy (61%), and 6 patients underwent diverticulectomy alone (17%). There were a total postoperative (4 patients). None of the patients had in-hospital or 30-day mortality.

Conclusion: Although in this era, minimally invasive approach is the first choice for diverticulectomy; however, we observed that in our study the mortality and leak rates were as low as those of the previous studies. Hence, open approach could be safe and effective if it is performed by surgeons with high degree of expertise.