From the Research
The initial approach to managing a patient with an esophageal diverticulum should be a laparoscopic myotomy-first strategy, reserving diverticulectomy for patients with persistent or recurrent symptoms, as this approach reduces the risk of unnecessary surgery and complications. This approach is supported by a study published in 2019 1, which found that a laparoscopic Heller myotomy and partial fundoplication provided excellent resolution of symptoms for most patients with epiphrenic esophageal diverticula. The study reported that dysphagia resolved in 77% and regurgitation in 86% of patients, with only a few patients requiring a staged resection of the diverticulum.
When considering the management of esophageal diverticula, it is essential to prioritize the patient's symptoms and quality of life. The goal of treatment is to alleviate symptoms, prevent complications, and improve the patient's overall well-being. A laparoscopic myotomy-first approach is a minimally invasive procedure that can help achieve these goals while reducing the risk of complications and unnecessary surgery.
Some key points to consider when managing esophageal diverticula include:
- The patient's symptoms, such as dysphagia and regurgitation, should be carefully evaluated and managed.
- A laparoscopic myotomy-first approach can be an effective treatment option for patients with epiphrenic esophageal diverticula.
- Diverticulectomy should be reserved for patients with persistent or recurrent symptoms.
- The patient's quality of life and overall well-being should be prioritized when making treatment decisions.
It is also important to note that other studies have reported on the management of esophageal diverticula, including the use of diverticulectomy and myotomy 2, 3, 4, 5. However, the most recent and highest quality study 1 supports the use of a laparoscopic myotomy-first approach as the initial management strategy for patients with esophageal diverticula.