An epiphrenic oesophageal diverticulum develops as the result of increased pressure in the oesophageal wall (pulsion diverticulum). The diverticulum is located in the distal 10 cm of the oesophagus, with herniation of mucosa and submucosa through the muscularis propria, usually towards the right in the mediastinum (1). The median size of diverticula varies from 4 cm to 7 cm (range 1 – 14 cm) in different datasets (1). Up to 15 % of patients have two or more diverticula. Oesophageal motility disorders such as non-specific dysmotility, diffuse oesophageal spasm, achalasia and increased pressure in the lower oesophageal sphincter occur in 75 – 100 % of patients (1).
Oesophageal diverticula are detected in < 1 % of upper endoscopies and are assumed to cause 1 – 3 % of all cases of dysphagia (2). Radiological studies indicate that the prevalence of epiphrenic diverticula in the general population is 0.015 % in the USA (3) and 0.04 – 0.15 % in Japan (4). In a more selective dataset from Europe, epiphrenic diverticula were found in 2 % of patients who were examined for swallowing disorders (5). The estimated annual incidence in the USA is about 1 per 500 000 individuals (6). The fact that epiphrenic diverticulum is a rare condition is also reflected in the small datasets in published material, ranging from 3 – 35 patients.
Between 37 and 63 % of diverticula are reported to cause symptoms (1). The most common are dysphagia, regurgitation, pain on swallowing food and weight loss (1). Diverticula that cause mild or no symptoms seldom progress to a symptomatic disease (6). In cases of large, symptomatic diverticula, there is increased risk of complications related to the diverticulum, such as aspiration pneumonia. Conservative treatment targets reflux, if any. In some cases, balloon dilation may be attempted in cases of achalasia with stenosis and increased pressure in the lower oesophageal sphincter (6).
The original surgical procedure was left-side thoracotomy with dissecting free and resection of the diverticulum (1, 2). In cases of concomitant achalasia or increased pressure in the lower oesophageal sphincter it is increasingly common to perform myotomy of the oesophagus on the opposite side of the diverticulum and an antireflux operation, normally with partial fundoplication, to counteract acidic and alkaline gastro-oesophageal reflux (1).
Surgery is increasingly performed in a minimally invasive manner, and most frequently by means of laparoscopy (1). A dataset of 133 patients who underwent surgery in the period 1995 – 2008 (7) revealed that two had died during the operation. Post-operative morbidity was reported in 21 %, including leakage from the oesophagus in 15 % of the patients.
The main purpose of this study was to evaluate the post-surgery results for patients who had undergone surgery for epiphrenic oesophageal diverticulum in the period 2002 – 2012 at Oslo University Hospital, Ullevål.