Minimally invasive management of epiphrenic diverticulum

Esophageal diverticula are classified by both their anatomic location and by their mechanism of formation. Anatomically, esophageal diverticula are usually present at three locations: the pharyngoesophageal junction, the mid-esophagus, and the epiphrenic region. Another way of classifying esophageal diverticula is by their pathophysiologic origin: pulsion or traction. Pulsion diverticula occur secondary to an increase in intraluminal pressure and traction diverticula are caused by forces pulling from outside the esophagus. Pulsion diverticula are usually "false" and involve only the mucosal and submucosal layers. Conversely, true diverticula (traction) involve all layers of the esophagus (mucosa, submucosa, and muscularis) and are most commonly located in the mid-thoracic region where chronic inflammation from mediastinal disease (e.g., tuberculosis, histoplasmosis, or malignancy) can exert external traction on the esophageal wall. Pharyngoesophageal diverticula, also known as Zenker's, are more common than epiphrenic and mid-body esophageal diverticula (Yam et al., Esophageal diverticula, StatPearls, Treasure Island (FL), 2021, Brandeis et al., Am J Surg 216(2):280-5, 2018, Fisichella et al., World J Surg 39(7):1614-9, 2015, Jalilvand and Fisichella, Esophageal diseases: evaluation and treatment, Springer International Publishing, Cham, pp 109-18, 2014). While a variety of management strategies are available to treat each of these separate conditions, this review will focus on the comprehensive diagnostic assessment, perioperative management, and postoperative care of epiphrenic diverticula (ED). By the end of this chapter, the reader will have a thorough understanding of current management strategies for ED and key tips for the perioperative management of patients following their repair.