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Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker?s Oesophageal Diverticula

Chan, David, Foliaki, Antonio, Lewis, Wyn G., Clark, Geoffrey W. B. and Blackshaw, Guy R. J. C. 2017. Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker?s Oesophageal Diverticula. Journal of Gastrointestinal Surgery 21 (6) , pp. 1067-1075. 10.1007/s11605-017-3368-3

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Abstract

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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Postgraduate Medical and Dental Education
Publisher: Springer
ISSN: 1091255X
Date of First Compliant Deposit: 5 April 2017
Date of Acceptance: 9 January 2017
Last Modified: 07 Dec 2019 03:45
URI: http://orca-mwe.cf.ac.uk/id/eprint/99665

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