P1.010. Personalized Approach to Surgical Treatment of Epiphrenal Diverticula of the Esophagus

Abstract

Abstract Topic Benign Disease: Esophageal Surgery Background Epiphrenal diverticula of the esophagus are a rare pathology, pathogenetically associated with disorders of esophageal motility. Despite the evolution of treatment methods towards minimally invasiveness, the incidence of postoperative complications (suture failure) remains high (up to 45%), which necessitates the search for new approaches to surgical tactics. Methods The prospective study included 7 patients with symptomatic epiphrenal diverticula who were treated in the period 2023-2025. All patients underwent a comprehensive preoperative examination, including EGDS, X-ray contrast examination, CT and esophageal manometry with endoscopic assistance. Motor disorders were diagnosed in 100% of patients (achalasia of the cardia — 28.5%, hyperkinetic disorders — 71.5%). The treatment was carried out in two stages: the first stage was oral endoscopic myotomy (POEM) for all patients. The second stage (while maintaining symptoms and contrast retention) was thoracoscopic diverticulectomy. Results The first stage (POEM) allowed for complete relief of symptoms in 4 out of 7 patients (57%), eliminating the need for diverticulectomy. Three patients (43%) with persistent regurgitation and contrast delay underwent second-stage thoracoscopic diverticulectomy. No intraoperative complications or deaths were recorded. The average bed day after POEM was 1.2 days, and 4.5 days after diverticulectomy. Conclusion The proposed step-by-step strategy with the initial implementation of POEM makes it possible to objectively assess the contribution of the motor component to the clinical picture and avoid unjustified traumatic diverticulectomy in some patients. A personalized approach based on data from control interim studies helps to reduce the risks of surgical complications and improve the functional outcomes of treatment of epiphrenal diverticula of the esophagus.