• Journal of Chest Surgery
• /
• v.23 no.3
• /
• pp.584-587
• /
• 1990

Recently we experienced one, case of epiphrenic esophageal diverticulum of a 50 - year - old female patient who had complained heaviness in her chest after meals and occasional dysphagia for one year. Preoperative barium study showed a large epiphrenic esophageal diverticulum at about 7cm above the diaphragm which protruded to the right side of the mid thorax. On the operation field, epiphrenic esophageal diverticulum, measuring 5x 6x3cm in size, was noted. Diverticulectomy and extended myotomy was performed and the postoperative course was uneventful.

• Journal of Chest Surgery
• /
• v.52 no.1
• /
• pp.40-43
• /
• 2019

Epiphrenic diverticula are known to cause a series of complications. We report the case of a 54-year-old woman who was diagnosed with an epiphrenic diverticulum at a regular checkup in November 2006. Ten years later, she presented with massive hematemesis. Imaging studies revealed an epiphrenic diverticulum measuring 7.8 cm in diameter and a large amount of bleeding inside the diverticulum. Computed tomography showed fistula formation between the diverticulum and the left lower lobe of the lung, leading to the development of a pulmonary abscess. Diverticulectomy and $180^{\circ}$ posterior partial fundoplication were performed transabdominally. The pulmonary abscess was treated with antibiotics alone. She was discharged 16 days after the operation without any complications over 7 months of follow-up.

• Journal of Chest Surgery
• /
• v.21 no.5
• /
• pp.924-928
• /
• 1988

Diffuse esophageal spasm[DES] is a rare disease, and its surgical management is controversial. We experienced one case of diffuse esophageal spasm with a large epiphrenic diverticulum. We resected the diverticulum with right side approach and underwent extended esophageal myotomy from the apex of the chest to 3 cm above the diaphragm. And then we preserved the LES without antireflux procedure.

• Journal of Chest Surgery
• /
• v.52 no.4
• /
• pp.227-231
• /
• 2019

Background: There is no established surgical procedure for the treatment of epiphrenic esophageal diverticulum. The aim of this study was to compare the clinical outcomes of esophageal diverticulectomy using abdominal and thoracic approaches. Methods: We retrospectively reviewed 30 patients who underwent esophageal diverticulectomy through the thoracic or abdominal approach for an epiphrenic diverticulum at a single center between 1996 and 2018. We compared clinical outcomes, including the postoperative length of stay, time from the operation to oral feeding, leakage rate, and reoperation rate between the 2 groups. Results: The median age was 56 years. Of the 30 patients, 18 (60%) underwent diverticulectomy via the thoracic approach and 12 (40%) underwent the abdominal approach. The median hospital stay was 10 days (range, 5-211 days) in the thoracic approach group and 9.5 days (range, 5-18 days) in the abdominal approach group. The median time from the operation until oral feeding was 6.5 days (range, 3-299 days) when the thoracic approach was used and 5 days (range, 1-11 days) when the abdominal approach was used. In the thoracic approach group, the leakage rate was 16.67% and the reoperation rate was 27.78%. However, there were no cases of leakage or reoperation in the abdominal approach group. Conclusion: The abdominal approach for esophageal diverticulectomy is a feasible and appropriate alternative to the thoracic approach.

• Journal of Chest Surgery
• /
• v.14 no.4
• /
• pp.364-368
• /
• 1981

There is collected cases report of esophagus diverticulum .treated at the dept. of Thoracic & Cardiovascular surgery of National Medical Center During the past 21 years from 1960 to 1981 . The total number were l0 cases in consideration of their sites, the pharyngoesophageal diverticulum was only one, the cervical esophageal diverticulum one, the mid thoracic diverticulum were Six, and the epiphrenic diverticulum were two. And their pathogenetic analysis revealed 6 in traction type, and 4 in pulsion type. The investigation and analysis have been done in comparison with current concept of esophageal diverticulum.

• Journal of Chest Surgery
• /
• v.13 no.3
• /
• pp.312-318
• /
• 1980

The first case was a 20 year old female who has been suffered from epigastric pain, and anorexia for 2 years. A thumb tip sized pulsion diverticulum 4cm above the esophagocardial junction was elicited by esophagogram and on exploration. A diverticulectomy with long esophagocardiomyotomy was performed. The second case was a 30 year old house wife who has had postprandial epigastric pain for 2 months accompained with frequent vomiting. Fiberscopy and esophagogram showed epiphrenic diverticulum of the esophagus. Same operative procedures were carried out and obtained a good result as first case. The third case was a 55 year old house wife who was admitted to this Chest Surgery Department because of regurgitation and intermittent vomiting for approximately 3 months. Esophagogram showed a large epiphrenic diverticulum of the esophagus. On exploration, a tennis ball sized pulsion diverticulum was found on the anterolateral wall of the esophagus. A partial esophagectomy including the diverticulum and esophagoesophagostomy was performed. The specimenshowed some erosive changes of the mucosal surface of the diverticulum and also the esophagus suggestive of diverticulitis and esophagitis. She has been satisfactory result until 4 months postoperatively, when she developed regurgitation and epigastric pain. Esophagogram showed stenosis of the operative site. Readmission and esophageal dilatations were done and improved without any problem. Epiphrenic or supradiaphragmatic diverticulum of the esophagus is a rare condition. Pathophysiologically, the conditions accompanied the spasm of the esophagus, many authors prefered the procedures of a diverticulectomy plus long esophagocardiomyotomy rather than simple diverticulectomy or esophagectomy and esophagoesophagostomy. Here we report the cases and reviewed the literatures.

• Journal of Chest Surgery
• /
• v.25 no.12
• /
• pp.1537-1541
• /
• 1992

Eleven patients with esophageal diverticulum were operated on between August 1982 and August 1992 at the Department of Thoracic and Cardiovascular Surgery of Chonnam National University Hospital have been studied. 9 patients were male and 2 were famale and the age distribution was between 20 and 55 years. Various subjective symptoms were noticed preoperatively. Diagnosis was confirmed by esophagography. The types of esophageal diverticulum were traction type in 6 cases and pulsion type in 5 cases. There were nine cases of midesophageal diverticula, 1 cases of upper-thoracic esophageal diverticulum and 1 cases of epiphrenic diverticulum. Diverticulectomy alone in 10 cases and diverticulopexy was performed in 1 case. Fistulectomy in 5 cases, lobectomy in 1 case, segmentectomy in 1 case, and Eloesser`s procedure in 1 case were performed with associated procedures. There were no death or morbidity and all patients have achieved marked improvement of symptoms except three patients who had a concomitant mucoepidermoid tumor, had a complicated postoperative pyothorax, and had a postoperative recurrence of midesophageal diverticulum. Recurrence of symptoms were not noticed during follow up except 1 recurrence of diverticulum confirmed by esophagogram.

• Journal of Chest Surgery
• /
• v.22 no.2
• /
• pp.265-271
• /
• 1989

Sixteen patients with esophageal diverticulum operated on between July 1979 and September 1988 at the Department of Thoracic Surgery of National University Hospital have been studied. There were 2 cases of the pharyngoesophageal diverticula, 12 cases of the midesophageal diverticula, and 2 cases of the epiphrenic diverticula. Twelve cases of midesophageal diverticula consisted of 9 cases of pulsion type and 3 cases of traction type. There were 13 women and three men, whose ages ranged from 25 to 65 years with an average age of 45.5 years. Diverticulectomy alone in three cases, diverticulopexy with myotomy in two cases, and diverticulectomy with myotomy in 11 cases were performed. There were no deaths or morbidity and all patients have achieved marked improvement of their symptoms except four patients who had a concomitant hypopharyngeal carcinoma, had a postoperative recurrence in epiphrenic diverticulum, and had two cases of postoperative transient regurgitation which subsided spontaneously one and one and half year later.

• Clinical Endoscopy
• /
• v.56 no.1
• /
• pp.23-37
• /
• 2023

Submucosal endoscopy or third-space endoscopy utilizes the potential space between the mucosal and muscularis layers of the gastrointestinal tract to execute therapeutic interventions for various diseases. Over the last decade, endoscopic access to the submucosal space has revolutionized the field of therapeutic endoscopy. Submucosal endoscopy was originally used to perform endoscopic myotomy in patients with achalasia cardia, and its use has grown exponentially since. Currently, submucosal endoscopy is widely used to resect subepithelial tumors and to manage refractory gastroparesis and Zenker's diverticulum. While the utility of submucosal endoscopy has stood the test of time in esophageal motility disorders and subepithelial tumors, its durability remains to be established in conditions such as Zenker's diverticulum and refractory gastroparesis. Other emerging indications for submucosal endoscopy include esophageal epiphrenic diverticulum, Hirschsprung's disease, and esophageal strictures not amenable to conventional endoscopic treatment. The potential of submucosal endoscopy to provide easy and safe access to the mediastinum and peritoneal spaces may open doors to novel indications and rejuvenate the interest of endoscopists in natural orifice transluminal endoscopic surgery in the future. This review focuses on the current spectrum, recent updates, and future direction of submucosal endoscopy in the gastrointestinal tract.

• Korean Journal of Bronchoesophagology
• /
• v.15 no.2
• /
• pp.87-91
• /
• 2009

Esophageal diverticulum is a rare entity, the true incidence of which is unknown, mainly because there are usually no clinical symptoms. Most esophageal diverticulum are found incidentally during an endoscopic or radiologic examination. Their classification is based on anatomical location; namely, upper third(Zenker or pharyngoesophageal), middle third(thoracic), or lower third(epiphrenic). Here we report a 52-years-old female presenting with dysphagia and regurgitation. Esophagogram showed esophageal diveticulum at lower cervical esophagus. Its positional aspect, it is different from Zenker's diveticulum. Treatment is surgical via an endoscopic or external approach. In view of the patient's age and anatomical location, various surgical approaches were considered as a therapeutic option for the management. This paper presents our experience in the management of esophageal diverticulum which was unusual location and stapled open resection without sternotomy.