Laparoscopic repair of a large symptomatic epiphrenic esophageal diverticulum

Laparoscopic approach in the treatment of large epiphrenic esophageal diverticulum

Epiphrenic diverticulum of the lower third of the esophagus is a relatively rare disorder. We present the case of a large, 7.5 cm diameter esophageal epiphrenic diverticulum treated by the laparoscopic approach. Surgery was indicated by the severity of the patient‘s symptoms and size of the diverticulum. A laparoscopic transhiatal diverticulectomy with a myotomy and Dor fundoplication was carried out. The overall operative time was 180 min. The patient tolerated the surgery well and was discharged from hospital 4 days after the surgery. From the 10^th postoperative day the patient resumed a regular diet. Four weeks after the operation the patient had no complaints, symptoms of dysphagia or vomiting. The laparoscopic approach in the treatment of a large, 7.5 cm epiphrenic diverticulum of the esophagus is feasible, safe and well tolerated by the patient.

Esophageal diverticula: Analysis of 25 cases

BACKGROUND

esophageal diverticula are classified as 2 types: true diverticula and pseudodiverticula. These disorders result in clinical manifestations such as dysphagia and esophageal reflux. In this study, we evaluated the results of surgical treatment for diverticula.

METHODS

all patients suffering from symptomatic esophageal diverticulum, who underwent surgical treatment in Ghaem Hospital from 2000 to 2012 and were followed up for at least for one year, were included in the study. Age, sex, clinical manifestations, location, surgical approach, and mortality were evaluated. There were 25 patients (15 men and 10 women) with a mean age of 41 ± 8.3 years.

RESULTS

the most common site of involvement was inferior (epiphrenic diverticulum). Barium swallow was diagnostic. After surgical treatment, complications occurred in 4 (16%) patients, comprising anastomosis site leakage, hoarseness, atelectasis, and wound infection; all were treated medically. There was no postoperative mortality. All patients experienced an improvement in symptoms during one year of follow-up.

CONCLUSION

due to the good results and minimal complications postoperatively, surgical treatment is recommended for patients with symptomatic esophageal diverticulum.

Squamous cell carcinoma in a large epiphrenic esophageal diverticulum

Carcinoma is rare in an esophageal diverticulum. The case of a 53-year-old man with a large mass in a long-standing symptomatic epiphrenic esophageal diverticulum is presented in this study. Squamous cell carcinoma in the diverticulum with pleural invasion was diagnosed after surgical diverticulectomy. The patient underwent subtotal esophagectomy with locoregional lymph node dissection and reconstruction with gastric tube because of micro-invasion at the surgical margin. The patient developed malignant pleural effusion at 6 months after surgery, and he eventually expired 3 months later. Carcinoma can develop in esophageal diverticula and is usually diagnosed at an advanced stage with poor prognosis.

Tratamento cirúrgico dos divertículos epifrênicos por videolaparoscopia

OBJETIVO: O objetivo deste trabalho é registrar o tratamento cirúrgico de cinco pacientes operados por meio da videolaparoscopia, comentar a técnica empregada e apresentar os resultados obtidos. MÉTODO: São relatados cinco casos de tratamento cirúrgico videolaparoscópico de pacientes portadores de divertículo epifrênico. Três pacientes, cuja idade variou de 37 a 64 anos, eram do sexo feminino. Todos foram submetidos aos exames de endoscopia e contrastado do esôfago para confirmação do diagnóstico. A manometria foi realizada em três pacientes, que demonstrou alterações motoras inespecíficas. RESULTADOS: Em todos os pacientes, a operação foi realizada por abordagem videolaparoscópica, tendo sido feita a ressecção do divertículo, hiatoplastia e fundoplicatura. A complicação mais importante foi uma fístula na linha de sutura do esôfago após oito dias, apesar de o exame contrastado de controle ter sido normal. O tempo de internação variou de 7 a 21 dias (média de 9,8 dias) e todos tiveram melhora da disfagia no acompanhamento de 2 a 11 anos. CONCLUSÕES: O tratamento cirúrgico do divertículo epifrênico pode ser realizado por videolaparoscopia, Essa via de acesso traz o benefício de um pós-operatório com menor dor, taxa de complicação aceitável e tempo de internação compatível com o porte da cirurgia. Por demonstrar ser segura e eficiente na resolução dos sintomas, hoje a técnica de escolha para o tratamento do divertículo epifrênico, em mãos experientes, pode ser considerada a primeira escolha.