Minimally Invasive Techniques in the Contemporary Management of Esophageal Diverticula

INTRODUCTION: Management of esophageal diverticulum has shifted from an expansive, open operative approach to a varied open and select endoscopic intervention. This study examines operative outcomes in patients with esophageal diverticula treated with varied approaches at a single academic center. METHODS: A retrospective review of a prospectively maintained database was performed for all patients who underwent operation for esophageal diverticula at a single institution. The patients were grouped by location: Group A (Zenker’s), group B (mid-esophageal), and group C (epiphrenic diverticula). Measured outcomes include postoperative complication, symptoms, and recurrence. RESULTS: A total of 27 patients who underwent operation for symptomatic esophageal diverticula from June 2010 to June 2018 were identified. The mean age was 66.6 years, and 29.6% were women. Mean follow-up was 14 months. Group A consisted of 14 patients, group B 7, and group C 6. Preoperative dysphagia occurred in 81.5% of all patients. Underlying motility disorders were present in 92.3% of group B and C patients. A total of 92% of patients in group A underwent attempted endoscopic resection, with 42.9% converting to open. Robotic-assisted surgery was performed in 100% of group B and 83.3% of group C patients. One esophageal leak occurred in group A; there were no mortalities. Only group A demonstrated radiographic recurrence at 42.8%. Recurrent dysphagia in group A was 50%, group B 28.6% (2/7), and group C 0%. CONCLUSION: Minimally invasive management of esophageal diverticula provides effective symptom resolution. This study verifies the safety of endoscopic, laparoscopic, and robotic approaches with a 0.04% leak rate.