Systematic Review and Meta-analysis of Surgical Treatment of Non-Zenker's Oesophageal Diverticula

被引:33
作者
Chan, David S. Y. [1 ]
Foliaki, Antonio [1 ]
Lewis, Wyn G. [1 ]
Clark, Geoffrey W. B. [1 ]
Blackshaw, Guy R. J. C. [1 ]
机构
[1] Univ Wales Hosp, Dept Surg, Heath Pk, Cardiff CF14 4XW, S Glam, Wales
关键词
Oesophageal diverticula; Myotomy; EPIPHRENIC DIVERTICULA; MANAGEMENT; MYOTOMY; EXPERIENCE; OPERATION; SURGERY; REPAIR;
D O I
10.1007/s11605-017-3368-3
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Oesophageal diverticula are rare outpouchings of the oesophagus which may be classified anatomically as pharyngeal (Zenker's), mid-oesophageal and epiphrenic. While surgery is indicated for symptomatic patients, no consensus exists regarding the optimum technique for non-Zenker's oesophageal diverticula. The aim of this study was to determine the outcome of surgery in patients with non-Zenker's oesophageal diverticula. Methods PubMed, MEDLINE and the Cochrane Library (January 1990 to January 2016) were searched for studies which reported outcomes of surgery in patients with non-Zenker's oesophageal diverticula. Primary outcome measure was the rate of staple line leakage. Results Twenty-five observational studies involving 511 patients (259 male, median age 62 years) with mid-oesophageal (n = 53) and epiphrenic oesophageal (n = 458) diverticula who had undergone surgery [thoracotomy (n = 252), laparoscopy (n = 204), thoracoscopy (n = 42), laparotomy (n = 5), combined laparoscopy and thoracoscopy (n = 8)] were analysed. Myotomy was performed in 437 patients (85.5%), and anti-reflux procedures were performed in 342 patients (69.5%). Overall pooled staple line leak rates were reported in 13.3% [95% c.i. (11.0-15.7), p < 0.001] and were less common after myotomy (12.4%) compared with no myotomy (26.1%, p= 0.002). Conclusions No consensus exists regarding the surgical treatment of non-Zenker's oesophageal diverticula, but staple line leakage is common and is reduced significantly by myotomy.
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页码:1067 / 1075
页数:9
相关论文
共 38 条
[1]   Is Resection of an Esophageal Epiphrenic Diverticulum Always Necessary in the Setting of Achalasia? [J].
Allaix, Marco E. ;
Borraez Segura, Bernardo A. ;
Herbella, Fernando A. ;
Fisichella, Piero M. ;
Patti, Marco G. .
WORLD JOURNAL OF SURGERY, 2015, 39 (01) :203-207
[2]   THORACIC ESOPHAGEAL DIVERTICULA - WHY IS OPERATION NECESSARY [J].
ALTORKI, NK ;
SUNAGAWA, M ;
SKINNER, DB ;
ATTAR, S ;
STREITZ, JM ;
MARK, JBD ;
COOK, WA ;
FABER, LP .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1993, 105 (02) :260-264
[3]  
[Anonymous], ASIAN CARDIOVASC THO
[4]   FUNCTIONAL DISEASED OF ESOPHAGUS [J].
BELSEY, R .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1966, 52 (02) :164-&
[5]   EPIPHRENIC DIVERTICULUM - RESULTS OF SURGICAL-TREATMENT [J].
BENACCI, JC ;
DESCHAMPS, C ;
TRASTEK, VF ;
ALLEN, MS ;
DALY, RC ;
PAIROLERO, PC .
ANNALS OF THORACIC SURGERY, 1993, 55 (05) :1109-1114
[6]   Heller myotomy with esophageal diverticulectomy: an operation in need of improvement [J].
Bowman, Ty A. ;
Sadowitz, Benjamin D. ;
Ross, Sharona B. ;
Boland, Andrew ;
Luberice, Kenneth ;
Rosemurgy, Alexander S. .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2016, 30 (08) :3279-3288
[7]   Tailored surgery for esophageal body diverticula [J].
Castrucci, G ;
Porziella, V ;
Granone, PL ;
Picciocchi, A .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 1998, 14 (04) :380-386
[8]   Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum [J].
D'Journo, X. B. ;
Ferraro, P. ;
Martin, J. ;
Chen, L. -Q. ;
Duranceau, A. .
BRITISH JOURNAL OF SURGERY, 2009, 96 (08) :892-900
[9]   Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results [J].
Del Genio, A ;
Rossetti, G ;
Maffettone, V ;
Renzi, A ;
Brusciano, L ;
Limongelli, P ;
Cuttitta, D ;
Russo, G ;
Del Genio, G .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2004, 18 (05) :741-745
[10]  
FEKETE F, 1992, HEPATO-GASTROENTEROL, V39, P97