RT Book, Section
A1 Hunter, John G.
A1 Spight, Donn H.
A1 Sandone, Corinne
A1 Fairman, Jennifer E.
SR Print(0)
ID 1162530076
T1 Epiphrenic Diverticulectomy with Myotomy and Fundoplication
T2 Atlas of Minimally Invasive Surgical Operations
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071449052
LK accesssurgery.mhmedical.com/content.aspx?aid=1162530076
RD 2024/04/19
AB Epiphrenic  diverticula  usually  protrude  from  the  right  wall  of  the  esophagus  just  above  the  gastroesophageal  (GE)  junction  (Figure  1).  They  are  usually  associated  with  esophageal  motility  disorders,  either  diffuse  esophageal  spasm  or  achalasia.  Even  when  preoperative  esophageal  motility  does  not  detect  a  hypertensive  nonrelaxing  lower  esophageal  sphincter  (LES),  the  treatment  of  choice  for  these  lesions  includes  esophageal  myotomy  and  diverticulectomy.  Small,  low-lying  epiphrenic  diverticula  can  be  managed  from  the  abdomen  through  the  diaphragmatic  hiatus.  Large-mouth  diverticula  (greater  than  3  cm)  and  those  more  than  3  cm  above  the  hiatus  should  be  approached  through  a  right  thoracoscopic  approach  as  described  in  chapter  12.  The  chronically  inflamed  tissue  often  found  adjacent  to  a  diverticulum  and  the  limited  exposure  of  the  mediastinum  through  an  abdominal  approach  makes  the  transdiaphragmatic  approach  to  large  diverticula  technically  difficult  and  more  hazardous  than  is  necessary.