1. Dysphagia in middle age man Dr Daniela Munteanu Institute of Gastroenterology and Liver Disease Soroka University Medical Center

8. What is the diagnosis?

9. בדיקת גסטרוסקופיה

10. What to do with the patient?

11. esophagus vagus diverticulum

16. Renato Soares,j Gastrointest Surg(2010)14:2009-2015 85% 20 Varghese et al. 87% 23 D’Journo et al. 75% 20 Fernando et al. 81% 21 Tedesco et al. 100% 13 Del Genio et al. 85% 13 Melman et al. 100% 21 Nehra et al. PRIMARY ESOPHAGEAL MOTILITY DISORDER NUMBER OF PATIENTS AUTHOR

18. Management of epiphrenic diverticulum results of open operations for epiphrenic diverticulum 0% Overall-37.5% Leak-6% Resection alone-3 Resection +long myotomy-3 Myotomy of LES alone -10 16 Streitz et al. 1992 11% Reflux esophagitis-15% Reoperation-22% Leak-0% Resection alone-10 Right thoracotomy, resection, myotomy, fundoplication-10 Abdominal myotomy+fundoplivation-4, other-6 27 Feketc et al. 1992 Mortality rate Complication rate Technique used Number of cases series

19. 9% Overall-33% Leak-21% Left thoracotomy-32 Right thoracotomy-1 Myotomy+resection-22 Resection alone-7 Myotomy alone -1 33 Bennaci Et al. 1993 5.9% Leak-0% Lt.thoracotomy approach for all; myotomy, resection+Belsey-13 Myotomy,pexy+Belsey-1 Myotomy, resection+Nissen-1 17 Altorki et al. 1993 Mortality rate Complication rate Technique used Number of cases series

20. . 2.8% Leak-6% Open transthoracic operation : resection of the diverticulum, long esophagomyotomy, and antireflux operations 35 Varghese Et al. 2007 6% Reoperation-11% Leak-6% Lt. thoracotomy ,resection,myotomy-13 Lt.thoracotomy, pexy+ myotomy-4 Antireflux procedures: Dor-2,Modified Belsey-14, Nissen-1 17 Nehra Et al. 2002 Mortality rates Complication rates Technique used Number of cases series

21. Results of minimally invasive operations for epiphrenic diverticulum