BACKGROUND: Epiphrenic @entity7261 of the esophagus are often associated with a concomitant @entity1208 , which is thought to be the cause of the diverticulum and some of the @entity1 's symptoms. At one time @entity7261 were best removed via a left thoracotomy, but now the operation can be performed laparoscopically in most cases. We hypothesized that: (1) a @entity1957 is the underlying cause of the diverticulum; and (2) optimal treatment consists of laparoscopic resection of the diverticulum, a Heller myotomy, and @entity2911 fundoplication. METHODS: We performed a retrospective review of a prospectively collected database from a university hospital tertiary care center. Between June 1994 and December 2002, we evaluated 21 @entity1 with @entity7261 . An associated @entity1319 of the esophagus was found in 81% of @entity1 ( @entity1318 , 9%; diffuse esophageal @entity2473 , 24%; nonspecific @entity4423 , 24%; nutcracker esophagus, 24%). Seven (33%) of these @entity1 , all with @entity4423 , were referred for treatment. The laparoscopic operation entailed resection of the diverticulum (using an endoscopic stapler), a Heller myotomy, and a @entity2911 fundoplication. RESULTS: All operations were completed laparoscopically. The postoperative course of 6 @entity1 was uneventful and they left the hospital after 72 +/- 21 hours. In 1 @entity1 an acute @entity357 developed, which was repaired on the second postoperative day. Late follow-up (median 57 months) showed that all 7 @entity1 were asymptomatic. CONCLUSIONS: These data support the conclusions that: (1) a primary @entity4423 is the underlying cause of most @entity7261 ; and (2) laparoscopic treatment is successful and should be the method of choice. The diverticular neck can be exposed satisfactorily from the abdomen; a stapler inserted from this angle is better orientated to transect the neck than one inserted through a thoracoscopic approach. Furthermore, the myotomy and fundoplication are much more easily performed from the abdomen than from alternative approaches.

Cause and treatment of XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1318 :: ('MESH:D004931', 'Disease') :: ['achalasia'] @entity7261 :: ('MESH:D004240', 'Disease') :: ['epiphrenic diverticula', 'diverticula'] @entity357 :: ('MESH:D006551', 'Disease') :: ['paraesophageal hernia'] @entity1957 :: ('MESH:D019957', 'Disease') :: ['motor disorder'] @entity1208 :: ('MESH:D004935', 'Disease') :: ['esophageal motor disorder'] @entity2911 :: ('58476', 'Gene') :: ['Dor'] @entity2473 :: ('MESH:D013035', 'Disease') :: ['spasm'] @entity4423 :: ('MESH:D015154', 'Disease') :: ['esophageal motility disorder', 'esophageal dysmotility'] @entity1319 :: ('MESH:D015835', 'Disease') :: ['motility disorder']
@entity7261 :: (MESH:D004240,Disease) :: ['epiphrenic diverticula']
