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Meta-Analysis
. 2017 Jun;21(6):1067-1075.
doi: 10.1007/s11605-017-3368-3. Epub 2017 Jan 20.

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

David S Y Chan  1 , Antonio Foliaki  2 , Wyn G Lewis  2 , Geoffrey W B Clark  2 , Guy R J C Blackshaw  2
Affiliations
Meta-Analysis

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

David S Y Chan et al. J Gastrointest Surg. 2017 Jun.

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.

Keywords: Myotomy; Oesophageal diverticula.

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Figures

Fig. 1
Fig. 1
Identification process for eligible studies
Fig. 2
Fig. 2
Overall pooled staple line leak rate
Fig. 3
Fig. 3
Overall pooled treatment success rate
Fig. 4
Fig. 4
Overall pooled morbidity rate
See this image and copyright information in PMC

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