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Laparoscopic Excision of Esophageal Diverticulum

What is an esophageal diverticulum  

An esophageal diverticulum is an outpouching of mucosa through the muscular layer of the esophagus. It can be asymptomatic or cause dysphagia and regurgitation. Diagnosis is made by barium swallow; surgical repair my be required.

There are several types of esophageal diverticula, each of different origin.

  • Zenker's (pharyngeal) diverticula are posterior outpouchings of mucosa and submucosa through the cricopharyngeal muscle, probably resulting from an incoordination between pharyngeal propulsion and cricopharyngeal relaxation.
  • Midesophageal (traction) diverticula are caused by traction from mediastinal inflammatory lesions or, secondarily, by motility disorders.
  • Epiphrenic diverticula occur just above the diaphragm and usually accompany a motility disorder (achalasia, diffuse esophageal spasm).

 

Symptoms and Signs

A Zenker's diverticulum fills with food that might be regurgitated when the patient bends or lies down. Aspiration pneumonitis may result if regurgitation is nocturnal. Rarely, the pouch becomes large, causing dysphagia and sometimes a palpable neck mass.

Traction and epiphrenic diverticula are rarely symptomatic, although their underlying cause may be.

Diagnosis

All diverticula are diagnosed by videotaped barium swallow.

Treatment

  • if symptomatic
  • Usually require surgical resection

The surgery can be done laparoscopically in our centre.

 

 

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Dr Clement Tsang
Consultant Surgeon

Waratah Private Hospital clinic
Level 2, 31 Dora st Hurstville 2220

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