J Korean Surg Soc JKSS Journal of the Korean Surgical Society 1226-0053 The Korean Surgical Society 10.4174/jkss.2009.77.4.250 Original Article Surgical Treatment of the Esophageal Diverticulum Ko Si Mon M.D. Kim Hyoung-Il M.D. Kim Choong Bai M.D. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. Corresponding author (cbkimmd@yuhs.ac) 10 2009 30 09 2009 77 4 250 256 10 04 2009 08 07 2009 Copyright © 2009 The Korean Surgical Society 2009 Purpose

Clinical presentation and surgical results of the esophageal diverticula were analyzed.

 Methods

Ten patients who underwent esophageal diverticulectomy with myotomy from May 1999 to May 2008 were reviewed retrospectively.

 Results

Three pharyngoesophageal, one midesophageal and six epiphrenic diverticula were observed and transcervical, right transthoracic and left transthoracic surgical approach were used respectively. All of these cases were pulsion type and diverticulectomy with esophageal myotomy were done. For those who had leiomyoma, enucleation was performed simultaneously. One postoperative leakage was observed and resolved with conservative management. At 3 months after surgery, all patients enjoyed satisfactory results except two patients. One patient still suffered dysphagia which was not improved after surgery and the other patient had asymptomatic gastroesophageal reflux disease which was found on the follow up esophagography.

 Conclusion

Crucial factors in the treatment of esophageal diverticulum are high index of suspicion indicated by clinical symptoms, differential diagnosis with other disease and confirmatory diagnosis with esophagography. Diverticulectomy with esophageal myotomy is an essential procedure for the low recurrence of diverticulum.

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Esophagographic finding of the esophageal diverticula. These preoperative esophagographies demonstrate (A) pharyngoesophageal, (B) midesophageal and (C) epiphrenic esophageal diverticula. A sac-like collection of esophagograffin can be seen.

Esophagogastroduodenoscopic finding of the esophageal diverticula. These preoperative esophagogastroduodenoscopies demonstrate (A) pharyngoesophageal, (B) midesophageal and (C) epiphrenic esophageal diverticula. There are food materials in the diverticula.

Esophagographic finding at 4th postoperative day. Postoperative esophagography confirms no leakage.

Preoperative patient characteristics and surgical results after surgery

*F = female; †M = male; ‡PE = pharyngoesophageal; §Mid = midesophageal; ∥Epi = epiphrenic; POD = postoperation day; **GERD = gastroesophageal reflux disease.

Symptoms at presentation