Scalable production of chitosan sub-micron particles by membrane ionotropic gelation process

Ionotropic gelation (IG) is a highly attractive method for the synthesis of natural water-soluble polymeric nanoparticles (NPs) and sub-micron particles (sMP) due to its relatively simple procedure and the absence of organic solvents. The method involves the electrostatic interaction between two ionic species of opposite charge. Although it is well studied at the laboratory scale, the difficulty to achieve size control in conventional bench-top process is actually a critical aspect of the technology. The aim of this work is to study the membrane dispersion technology in combination with IG as a suitable scalable method for the production of chitosan sub-micron particles (CS-sMPs). The two phases, one containing chitosan (CS) and the other containing sodium tripolyphosphate (TPP), were put in contact using a tubular hydrophobic glass membrane with a pore diameter of 1 μm. TPP (dispersed phase) was permeated through the membrane pores into the lumen side along which the CS solution (the continuous phase) flowed in batch recirculation or continuous single-pass operation mode. The influence of chemical variables (i.e. pH, concentration and mass ratio of polyelectrolyte species, emulsifier) and fluid-dynamic parameters (i.e. polyelectrolyte solution flow rate and their relative mass ratio) was studied to precisely tune the size of CS-Ps.

The evaluation of tactile dysfunction in the hand in type 1 diabetes: a novel method based on haptics

AIMS

We present an innovative method based on haptics for the evaluation of the sense of touch in the hand, in people affected by type 1 diabetes.

METHODS

Forty individuals affected by diabetes and 20 healthy controls took part in the study; the diabetes group was further divided into two subgroups based on vibration sensitivity in the lower limb. By means of a novel haptic device, tactile sensitivity in the fingertip was measured as the ability of the participants to discriminate slip motion speed.

RESULTS

Tactile sensitivity was significantly lower in individuals affected by diabetes as compared to controls. Depending on the subgroup, the difference from the controls was equal to 0.11 (95% CI from 0.029 to 0.186) and to 0.267 (95% CI from 0.198 to 0.336). Within the diabetes group, tactile sensitivity correlated with vibration sensitivity in the upper (p = 0.001) and lower limb (p = 0.003). A significant relationship between nerve conduction parameters and tactile sensitivity was found (p = 0.03). Finally, we combined the different predictors (clinical, vibratory and electroneurography data) by using cluster analysis; tactile sensitivity was found to be significantly different between different clusters (p = 0.004).

CONCLUSIONS

Early signs of tactile dysfunction in the hand were found in individuals affected by diabetes, even in absence of diabetic neuropathy. The protocol presented in this study is a promising tool for the assessment of tactile dysfunction in the hand in people affected by type 1 diabetes.

AB0125 IL-25 PARTICIPATES IN KERATINOCYTE-DRIVEN DERMAL MATRIX TURNOVER AND IS REDUCED IN SYSTEMIC SCLEROSIS (SSc) EPIDERMIS

Background

Evidence shows that dysfunctional SSc keratinocytes contribute to fibrosis by altering dermal homeostasis (1, 2). Whether interleukin-25 (IL-25), an IL-17 family member regulating many epidermal functions (3), takes part in skin fibrosis is unknown.

Objectives

To investigate the role of IL-25 in skin fibrosis.

Methods

The expression of IL-25 was evaluated by immunofluorescence and in situ hybridization in 10 SSc and 7 healthy donors (HD) skin biopsies. Epidermal equivalents (EE) reconstituted by primary HD keratinocytes were used as a model to study transcriptomic changes induced by IL-25 in the epidermis. RNA expression profile in EE was characterized by RNAseq. The conditioned medium (CM) from primary SSc and HD keratinocytes primed with IL-25 was used to stimulate fibroblasts. IL-6, IL-8, MMP-1, type-I collagen (col-I), and fibronectin production by fibroblasts was assessed by ELISA.

Results

SSc epidermis expressed lower levels of IL-25 compared to HD. In EE, IL-25 regulated several molecular pathways related to wound healing and extracellular matrix (ECM) remodeling. Compared to control CM, the CM from IL-25-primed keratinocytes enhanced the fibroblast production of MMP-1, IL-6, IL-8, but not of Col-I nor fibronectin. However, IL-25 significantly reduced the production of Col-I when applied directly to fibroblasts and partially inhibit α-smooth muscle actin (α-SMA) expression promoted by TGFβ. The activation of keratinocytes by IL-25 was receptor-dependent and evident after a very short incubation time (10 min), largely mediated by IL-1, suggesting enhanced and specific release of preformed mediators.

Conclusion

These results show that IL-25 participates to skin homeostasis and its decreased expression in SSc may contribute to skin fibrosis by favoring ECM deposition over degradation.

References

[1]Russo B, Brembilla NC, Chizzolini C. Interplay between Keratinocytes and Fibroblasts: A Systematic Review Providing a New Angle for Understanding Skin Fibrotic Disorders. Frontiers in immunology. 2020; 11:648.

[2]Russo B, Borowczyk J, Boehncke WH, Truchetet ME, Modarressi A, Brembilla NC, et al. Dysfunctional keratinocytes increase dermal inflammation in systemic sclerosis. Results from tissue-engineered scleroderma epidermis. Arthritis & rheumatology. 2021.

[3]Borowczyk J, Shutova M, Brembilla NC, Boehncke WH. IL-25 (IL-17E) in epithelial immunology and pathophysiology. J Allergy Clin Immunol. 2021.

Acknowledgements

We thank Natacha Civic and Mylène Docquier (Genomics Platform) for performing the RNA sequencing; Nicolas Laudet (Bioimaging Core Facility) for quantification of immune-histology, François Prodon and Olivier Brun for microscope imaging (Bioimaging Core Facility), Marie Ebrahim Malek and Laura de Luca (Histology Core Facility) for contribution to tissue preparation (all at University Medical Center, Geneva, Switzerland).

Disclosure of Interests

Barbara Russo: None declared, Julia Borowczyk: None declared, Pietro Cacialli: None declared, Philippe Moguelet: None declared, Marie-Elise Truchetet Speakers bureau: Abbvie, Lilly, SOBI and Boehringer Ingelheim, Ali Modaressi: None declared, Nicolò Brembilla: None declared, Julian Bertrand: None declared, Wolf-Henning Boehncke Speakers bureau: Abbvie, Almirall, BMS, Celgene, Leo, Lilly, Novartis, and UCB, Carlo Chizzolini Speakers bureau: GSK, Roche, Boehringer Ingelheim

SAT0289 THE INS AND OUTS OF EPIDERMAL DYSFUNCTION IN SYSTEMIC SCLEROSIS (SSC): RESULTS FROM A NOVEL TISSUE ENGINEERED EPIDERMAL EQUIVALENT FROM SSC KERATINOCYTES

Background:

Skin fibrosis is a hallmark of systemic sclerosis (SSc). It is commonly accepted that vascular damage, immune system activation and, abnormal fibroblasts-to-myofibroblasts differentiation are pathological capital features. Nevertheless, recent evidence portrays a potential role of the epidermis in the pathogenesis of SSc skin fibrosis (1, 2). This new angle on skin fibrosis pathogenesis is particularly attractive as the epidermis is an easy to access therapeutic target.

Objectives:

To dissect the potential epidermal dysfunction in SSc and its effect on dermis homeostasis, using a novel epidermal equivalent reconstituted from SSc keratinocytes.

Methods:

Primary keratinocytes and fibroblasts cell lines were generated from skin biopsies obtained from 6 SSc and 6 healthy donors (HD), upon informed consent and ethical approval. Epidermal equivalents (EE) were generated from 4 SSc and 6 HD keratinocytes. Skin and EE expression of the mitotic marker Ki67, of the differentiation markers (K10, involucrin, filaggrin, loricrin), and activation markers (K6, K16) was evaluated by immunohistochemistry. The transcriptomic profile of SSc keratinocytes in monolayer or stratified in EE was identified by RNAseq analysis. EE conditioned medium was used to stimulate fibroblasts. The fibroblast production of interleukin (IL)-6, IL-8, matrix metalloproteinase (MMP)-1, type-I collagen (col-I), and fibronectin was assessed by ELISA.

Results:

Compared to HD, immunohistochemistry revealed that SSc epidermis is characterized by aberrant premature differentiation and enhanced expression of activation markers associated with a lower mitotic rate of basal keratinocytes. Of interest, EE reconstituted from SSc keratinocytes reproduced most of the abnormalities observed in SSc epidermis. RNAseq analysis revealed that SSc keratinocytes, either cultured in monolayer or in EE, have a distinct transcriptomic profile compared to their HD counterpart, characterized by the downregulation of genes from the HOX family.

The supernatant of EE enhanced the production of IL-6, IL-8, MMP-1, col-I, and fibronectin by HD fibroblasts (p<0.05). Except for col-I and fibronectin, this effect was 2-fold higher in the presence of supernatant from EE reconstituted by SSc keratinocytes. Neutralization experiments indicated that IL-1 was, at least in part, responsible for keratinocyte-dependent fibroblasts activation.

Conclusion:

We established a novel epidermal equivalent tissue engineered from SSc keratinocytes, that recapitulates thein vivocharacteristics of SSc epidermis. Our preliminary data suggest that SSc keratinocytes have an intrinsic altered program of differentiation, possibly due to the downregulation of some HOX genes. This altered phenotype is associated with increased production of mediators that stimulate fibroblasts production of inflammatory cytokines. In this scenario, we may hypothesize that SSc epidermis participates in modifying the dermis environment, favoring the development of chronic inflammation and fibrosis.

References

[1]Takahashi T, Asano Y, Sugawara K, Yamashita T, Nakamura K, Saigusa R, et al. Epithelial Fli1 deficiency drives systemic autoimmunity and fibrosis: Possible roles in scleroderma. J Exp Med. 20317;214(4):1129-51.

[2]Nikitorowicz-Buniak J, Shiwen X, Denton CP, Abraham D, Stratton R. Abnormally differentiating keratinocytes in the epidermis of systemic sclerosis patients show enhanced secretion of CCN2 and S100A9. J Invest Dermatol. 2014;134(11):2693-702.

Disclosure of Interests:

Barbara Russo: None declared, Julia Borowczyk-Michalowska: None declared, Wolf-Henning Boehncke Consultant of: WHB received honoraria as advisor or invited speaker from Abbvie, Almirall, BMS, Celgene, Leo, Lilly, Novartis, UCB., Speakers bureau: WHB received honoraria as advisor or invited speaker from Abbvie, Almirall, BMS, Celgene, Leo, Lilly, Novartis, UCB., Nicolò Brembilla: None declared, Carlo Chizzolini Consultant of: Boehringer Ingelheim, Roche

Antiproliferative activity of novel isatinyl/indanyl nitrones (INs) as potential spin trapping agents of free radical intermediates

A series of ketonitrones derived from isatin and indanone (INs) were synthesized and evaluated for their antiproliferative activities against several human cancer cell lines. Then, the antioxidant properties of these substrates were measured by the DPPH test to report their biological activity in terms of their spin trapping action. In particular, one substrate has showed very high biological and scavenging activity, probably due to the strong correlation between its spin trapping activity and structure.

Synthesis and gas sorption behaviour of ZIF-90 with large pore volume

Stoichiometric triethylamine in methanol deprotonates the imidazole and yields 98% sub-micrometric ZIF-90 with no residual solvent in the pores.

Nitrones and nucleobase-containing spiro-isoxazolidines derived from isatin and indanone: solvent-free microwave-assisted stereoselective synthesis and theoretical calculations

Here, we present a highly efficient approach to nucleobase-containing spiro-isoxazolidines with potential biological activity starting from isatinyl/indanyl nitrones.

Molecular determinants of positive allosteric modulation of the human metabotropic glutamate receptor 2

BACKGROUND AND PURPOSE

The activation of the metabotropic glutamate receptor 2 (mGlu2 ) reduces glutamatergic transmission in brain regions where excess excitatory signalling is implicated in disorders such as anxiety and schizophrenia. Positive allosteric modulators (PAMs) can provide a fine-tuned potentiation of these receptors' function and are being investigated as a novel therapeutic approach. An extensive set of mutant human mGlu2 receptors were used to investigate the molecular determinants that are important for positive allosteric modulation at this receptor.

EXPERIMENTAL APPROACH

Site-directed mutagenesis, binding and functional assays were employed to identify amino acids important for the activity of nine PAMs. The data from the radioligand binding and mutagenesis studies were used with computational docking to predict a binding mode at an mGlu2 receptor model based on the recent structure of the mGlu1 receptor.

KEY RESULTS

New amino acids in TM3 (R635, L639, F643), TM5 (L732) and TM6 (W773, F776) were identified for the first time as playing an important role in the activity of mGlu2 PAMs.

CONCLUSIONS AND IMPLICATIONS

This extensive study furthers our understanding of positive allosteric modulation of the mGlu2 receptor and can contribute to improved future design of mGlu2 PAMs.

Glucocorticoids in systemic sclerosis: patients' beliefs and treatment adherence

OBJECTIVES

To investigate how chronic intake of glucocorticoids (GCs) is perceived by patients with systemic sclerosis (SSc) in terms of necessity and concerns, and whether such beliefs influence treatment adherence.

METHOD

Ninety-eight consecutive SSc patients who they had been taking oral GCs for > 3 months prior to the study were enrolled. All patients underwent a clinical evaluation and laboratory investigations, and were asked to complete four self-administered questionnaires: the Beliefs about Medicines Questionnaire (Specific-BMQ), the four-item Morisky Medication Adherence Scale (MMAS-4), the 36-item Short Form Health Survey (SF-36), and the Health Assessment Questionnaire Disability Index (HAQ-DI). Moreover, patients answered two additional questions investigating their knowledge about GC-related adverse events (AEs).

RESULTS

Seventy-seven patients (83.6%) believed in the necessity of GCs for maintaining health but 72.8% also reported concerns about potential AEs to GCs. A high adherence rate was recorded in 64.1% of patients. Only about 20% of patients reported knowing that a daily GC dose and treatment duration influence the burden of GC-related AEs. Patients who believed that GC-related AEs were influenced by the dose scored lower concerns (p = 0.043) and were more frequently labelled as accepting (perceiving high necessity and low concerns) (p = 0.009).

CONCLUSIONS

The majority of patients taking GCs perceived them as necessary, but high concerns about chronic GC use exist. Patients with a poorer knowledge of the factors associated with GC-related AEs and those with a poorer quality of life were the most worried about these compounds. Experimental studies assessing the efficacy of educational programmes aiming to increase the adherence to GC therapy should be planned in these patients.

Modified N,O-Nucleosides: Design, Synthesis, and Anti-tumour Activity

A preliminary library of modified N,O-nucleosides was prepared and tested on a selected number of human cancer lines that include SKOV3, SW480, and K562. Thymine, N-benzyl substituents, and aromatic rings contribute to an increase of the biological activity, up to 10–25 μM, that appeared also reliant on the calculated lipophilicity of the nucleosides, expressed as cLogP, where P represents the partition coefficient of a solute between n-octanol and water.

Methodologies to study the surface hydraulic behaviour of urban catchments during storm events

A good knowledge of the hydraulic behaviour of an urban catchment and its surface drainage system is an essential requirement to guarantee traffic and pedestrian safety. In many cases, inlets have been situated according to spatial density criteria. Indeed a more rational location of inlets on urban catchments must be defined according to an accurate analysis of the relationship between street flow and inlet hydraulic efficiency. Moreover we lack specific hazard criteria in terms of the maximum acceptable flow depths and velocities on the streets that do not cause problems to pedestrians. In this paper the results of two different experimental campaigns are presented. The first was carried out to evaluate inlet hydraulic efficiency; the second was carried out to address the pedestrian stability in urban flood conditions, whose aim was to propose new hazard criteria. On the basis of the experimental results, a methodology was developed to assess flood hazard in urban areas during storm events. If a refined topographic representation of urban areas is available, a two-dimensional numerical simulation of urban flooding can be performed using complete shallow water equations. According to this approach a numerical application for flood hazard assessment in a street of Barcelona is shown.

Abnormal glucose tolerance in children with cystic fibrosis: the predictive role of continuous glucose monitoring system

A long pre-diabetic phase of abnormal glucose tolerance is described in subjects with cystic fibrosis (CF) since childhood.

OBJECTIVE

The aims of the study were to compare oral glucose tolerance test (OGTT) and continuous glucose monitoring system (CGMS) in the diagnosis of altered glucose metabolism, and to longitudinally evaluate the role of CGMS in predicting glucose metabolism deterioration in children with CF.

METHODS

Seventeen children with CF and 14 controls were enrolled (mean age 13.3+/-3.0 years). All subjects underwent OGTT and CGMS registration. On the basis of OGTT, children were classified as normal glucose tolerance, impaired glucose tolerance (IGT), IGT plus at least one glucose value above 200 mg/dl at intermediate OGTT points (IGT+200) and CF-related diabetes (CFRD). HbA1c, glucose area under the curve, insulin sensitivity, and insulinogenic and disposition indexes were also considered. Subjects with CF underwent another OGTT after 2.5 years.

RESULTS

Baseline OGTT revealed 3/17 (7.6%) children with CF with at least one glucose value above 200 mg/dl (1 CFRD and 2 IGT+200), while CGMS revealed 6/17 (35.3%) children with glucose excursions above 200 mg/dl (P=0.010). None of the controls showed glucose over 200 mg/dl either at OGTT or at CGMS. At the 2.5-year follow-up OGTT, all the six subjects who had diabetic glucose excursion (i.e. >200 mg/dl) at baseline CGMS presented IGT+200 or CFRD. In logistic regression analysis, CGMS diabetic excursion was the strongest predictor of IGT+200 and CFRD (P<0.001).

CONCLUSIONS

CGMS could be a useful tool to predict glucose metabolism derangements in children affected by CF.

Bone and body composition analyzed by Dual-energy X-ray Absorptiometry (DXA) in clinical and nutritional evaluation of young patients with Cystic Fibrosis: a cross-sectional study

Background

the improved general therapy has led to reduced morbidity and mortality from Cystic Fibrosis (CF), and bone status may have a potentially greater clinical impact.

We investigated the correlation between the severity of the clinical condition, bone status and body composition parameters, in a group of children and young adults with CF.

Methods

we measured lumbar spine bone density and total body composition by dual energy x-ray absorptiometry (DXA) in 82 consecutive CF patients (42 males; median age: 13 years - range: 5-30). Eighty-two healthy subjects, matched for age, gender, height and pubertal stage were recruited as a control group.

Results

37 patients (45.1%) had a normal bone mineral density (BMD). A BMD reduction were observed in 45 (54.8%) patients. Lumbar spine Z score was positively related to Body Mass Index (BMI) and a higher Shwachman-Kulczycki score, and negatively related to Crispin-Norman score. A positive and significant correlation was also observed between lumbar spine Z score and total body composition.

Conclusion

a significant BMD reduction can be present early in CF children and adolescents. A careful follow up of bone status is required starting in childhood.

A facile Er(OTf)3-catalyzed synthesis of 2,3-unsaturated O- and S-glycosides

Er(OTf)(3) is a useful catalyst for the Ferrier rearrangement furnishing high yields of O- and S-glycosides. The transformation has wide applicability, cleaner reaction profiles, mild reaction conditions, and high stereoselectivity and the catalyst, which is also commercially available, can be recovered and reused.

Erbium(III) Chloride: a Very Active Acylation Catalyst

Erbium(iii) chloride is a powerful catalyst for the acylation of alcohols and phenols. The reaction works well for a large variety of simple and functionalized substrates by using different kinds of acidic anhydrides (Ac2O, (EtCO)2O, (PriCO)2O, (ButCO)2O, and (CF3CO)2), without isomerization of chiral centres. Moreover, the catalyst can be easily recycled and reused without significant loss of activity.

Clinical effects of early treatment with insulin glargine in patients with cystic fibrosis and impaired glucose tolerance

Diabetes mellitus is an increasing complication of cystic fibrosis (CF), as a result of the improved life expectancy. There is clear association between diabetes and increased morbidity and mortality. Lung function and clinical status deteriorate up to 2-4 yr before the diagnosis of CF-related diabetes (CFRD). The aim of our study was to evaluate the effects, on glucose homeostasis and clinical status, of the early treatment with insulin glargine in CF patients with impaired glucose tolerance (IGT). We selected six subjects with IGT diagnosed at oral glucose tolerance test (OGTT). Median age was 18.12 yr (range 9.2-27.8). Insulin glargine was administered at the median dosage of 0.3 U/kg/day (range 0.2-0.5). After the initial adjustment of the dosage, no patient manifested hypoglycemia during treatment. Median glycosylated hemoglobin (HbA1c) did not show any significant variation during treatment: it was 5.9% at baseline (range 5.5-6.2) and 6.1% (range 5.0-6.7) at the end of follow-up (p=0.496). Median body mass index (BMI) z-score significantly increased during treatment, from -0.95 (range -3.2-+0.6) at baseline to -0.5. (range -3.0-+0.9) at the end of follow-up (p=0.026). Lung function, measured by median forced expiratory volume in the first second (FEV1%), showed a mild but significant improvement during insulin treatment. It was 72.7% at baseline (range 41.5-98.4) and 76.7% (range 42.0-106.8) at the end of follow-up (p=0.027). No significant variation was found between the number of hospitalizations for clinical exacerbation (no./patient/yr) in the last 2 yr before treatment and during follow-up. Median number at baseline was 1.95/patient/yr (range 1-3) and 2.0/patient/yr (range 1-3) at follow-up (p=0.715). Our data seem to indicate that early insulin therapy can be safe, no patient manifested hypoglycemia or other adverse effects during treatment. Insulin is an anabolic hormone implicated in both lipid and protein metabolism. The appearance of IGT out of infections can indicate an early insulin deficiency, with a potential impact on the nutritional and clinical status of the patient, even before the appearance of overt diabetes. Larger controlled trials are necessary to verify if early insulin therapy is able to reduce the deterioration of nutritional status and lung function associated with the onset of IGT.

[Videolaparoscopic adrenalectomy in an unusual case of adrenal mycetoma]

The authors report a rare case of mycetoma of the adrenal gland. Mycetoma is a chronic, localized, non-contagious infection of cutaneous and subcutaneous tissue characterized by tumefaction, aggregates of aetiological agents (Actinomyces or true fungi). Sometimes an unusual site (other tissues or organs) is described in the literature, but to date no cases of adrenal gland mycetoma have been reported. The treatment of choice is surgical with associated penicillin and/or antifungal drugs. In the case reported surgical treatment is performed with a laparoscopic approach. This technique constitutes the gold standard in cases of benign neoplasms of the adrenal gland and incidentalomas. This therapeutic choice is open to criticism if a malignant neoplasm is suspected.

[Acute myocardial infarction complicated by ventricular aneurysm during pregnancy. A clinical case and review of the literature]

Acute myocardial infarction is an uncommon complication in pregnant women. The case of a 30-years-old patient who suffered of an acute myocardial infarction during the first trimester of pregnancy, with secondary development of left ventricular aneurysm is presented. She had a sudden death 3 months after delivery, while waiting for coronary arteriography.

[Laparoscopic surgical treatment of cholecysto-choledochal calculi. A single step solution]

The laparoscopic era has created a new basis for the management of choledocholithiasis. Many surgeons now regard laparoscopic cholecystectomy and exploration of the common bile duct as the "gold standard". The main advantages of single-stage treatment consist in a significantly shorter hospital stay, very low complication rates and a reduction of average hospital costs. Among 601 cases of cholelithiasis treated over the period from 1994 to 1999, we report 73 cases of common-bile-duct stones. Surgical sphincterotomy was performed in 20 cases and endoscopic sphincterotomy in 24; only in 7 cases was choledochotomy and/or hepaticojejunostomy (3 cases) performed for critical situations. Twenty-two cases of cholelithiasis were treated by laparoscopic cholecystectomy and exploration of the common bile duct. Stone extraction was obtained with a balloon catheter or Dormia basket via a choledochotomy. Surgery was completed by suturing, cholangiography and the placement of sub-hepatic drainages. No mortality or long-term complications were recorded with the laparoscopic procedure; only two immediate complications were reported, both of which were biliary leakages (9%) that resolved spontaneously. With the other procedures, high rates of mortality, morbidity, hospital admissions and technical failure were registered. We regard laparoscopic exploration of the common bile duct as the treatment of choice for bile-duct stones when combined with cholecystectomy. We reserve ERCP plus endoscopic sphincterotomy only for common-bile-duct stones alone, without a gallbladder or gallstones. Open surgery is performed in particular situations such as Mirizzi's syndrome or when other procedures have failed to yield satisfactory results.

[The epiphrenic esophageal diverticulum. Its transhiatal laparoscopic treatment]

A new laparoscopic surgical approach to treat an esophageal epiphrenic diverticulum is described. This is a rare disease. Today only 4 cases of laparoscopic transhiatal treatment with good results are reported in the literature. The present case report is an 80 years-old male with medium size epiphrenic diverticulum (10 cm) and very symptomatic dysphagia. Preoperative investigations include barium swallow, upper gastrointestinal endoscopy and esophageal manometry. The laparoscopic transhiatal treatment was carried out without difficulty. Diverticulectomy esophageal myotomy and partial gastric fundoplication (Dor) were performed. No postoperative complication was recorded and optimal result was achieved. In conclusion, the efficacy of laparoscopic approach is underlined and the short and medium-term results are satisfactory.