Open surgical management of oesophageal diverticulum.

Epiphrenic diverticula are defined as the herniation of the mucosa and submucosa through the muscular layers of the oesophageal wall in its lower third. An increased intraluminal pressure associated with an oesophageal motility disorder is usually present in the pathophysiology of the disease. Surgical treatment is indicated mostly in symptomatic patients. The current surgical treatment consists in: (i) removing the diverticulum; (ii) relieving the functional distal obstruction with an oesophageal myotomy including the lower oesophageal sphincter; and (iii) preventing an associated reflux by the addition of a non-obstructive partial fundoplication. Minimally invasive techniques have been reported, but traditional open procedures remain the treatment of choice of the disease.