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      Laparoscopic transhiatal oesophageal diverticulectomy: An experience of large epiphrenic oesophageal diverticulum and review literature

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          Abstract

          Epiphrenic diverticulum is a rare abnormality of the distal oesophagus. Both thoracic and abdominal approaches are suitable for this diverticulum. A 46-year-old male presented with complaints of regurgitation and chest pain for 2 years. Contrast-enhanced computed tomography of the neck, thorax, abdomen and oesophageal endoscopy revealed 12 cm × 10 cm size large intrathoracic oesophageal diverticulum. He underwent an elective laparoscopic transabdominal oesophageal diverticulectomy. Gastrograffin study on the first post-operative day did not reveal any leak. In this case report, we are sharing our experience in the management of large epiphrenic oesophageal diverticulum through a laparoscopic approach. The benefits of the laparoscopic approach include decreased morbidity because we can avoid large thoracotomy or laparotomy incision.

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          Surgical treatment of epiphrenic diverticula: a 30-year experience.

          B Marshall, Mark Orringer, Hakwan C. Lau … (2007)
          Epiphrenic diverticula are rare and associated with esophageal motility abnormalities. Their optimal surgical treatment is debated, mortality being 9% in the largest reported surgical series of 33 patients. Our experience with a traditional thoracic approach was reviewed to provide benchmark data against which newer surgical techniques can be measured. A retrospective review of 35 patients operated on for epiphrenic diverticula from 1976 to 2005 was conducted. All underwent open transthoracic operations: resection of the diverticulum, long esophagomyotomy, and antireflux operations (modified Belsey, 29 patients; Nissen, 4 patients) in 33 patients; resection and long myotomy alone in 1 patient; and plication, long myotomy, and Collis-Nissen in 1 patient. Preoperative assessment included barium esophagogram, flexible esophagoscopy, manometry, and standard acid reflux test. Operative complications and functional results were assessed. Median age was 71 years (range, 36 to 87 years). Diverticulum size averaged 6.4 cm (range, 3 to 14 cm). Sixty-eight percent presented to the right of the esophagus. The median duration of symptoms was 3 years. Presenting complaints included dysphagia (83%), regurgitation (69%), and chest pain (26%). Eighteen had a mean weight loss of 19 pounds. There was 1 perioperative death (2.8%) from a plicated diverticulum leak and one nonfatal suture line leak. Median hospital stay was 7 days. Mean follow-up was 45.3 months. Twenty-six patients (74%) had an excellent result (no residual symptoms). Seven required a periodic esophageal dilatation for intermittent mild dysphagia. Traditional transthoracic resection, long esophagomyotomy, and an antireflux procedure provide excellent long-term functional results with relatively low postoperative morbidity in patients with epiphrenic diverticula.
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            Epiphrenic diverticula mini-invasive surgery: a challenge for expert surgeons--personal experience and review of the literature.

            G Rossetti, L Fei, G Del Genio … (2013)
            While in the past, thoracotomy represented the traditional surgical approach for the treatment of epiphrenic diverticula, actually mini-invasive approach seems to be the preferred treatment as many series have been published in the recent years. This article describes the authors' experience with the laparoscopic approach for performing diverticulectomy, myotomy, and Nissen-Rossetti fundoplication.
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              Minimally invasive surgery for esophageal epiphrenic diverticulum: the results of 133 patients in 25 published series and our experience.

              Yuki Hirano, Hiroya Takeuchi, Takashi Oyama … (2013)
              Esophageal epiphrenic diverticula are uncommon. Traditionally, thoracotomy has been the preferred surgical approach. Recently, minimally invasive approaches have been reported in a few series. However, the best surgical approach remains uncertain. In this study, we review the results of 25 articles discussing laparoscopic or thoracoscopic surgery. From January 1995 to December 2008, there were a total of 133 patients reported in English-language journals in PubMed. Nineteen patients (14 %) underwent thoracoscopic surgery, 112 (84 %) laparoscopic surgery and two patients (2 %) were treated using a combination approach. The diverticulectomy was performed using an endostapler device in all patients. A myotomy was added in 103 patients (83 %). A fundoplication was added in 106 patients (85 %). There were two deaths during surgery (2 %). The post-operative morbidity rate was 21 %. The most severe complication was suture-line leakage, which occurred in 20 patients (15 %). Recently, we successfully treated a patient with an epiphrenic esophageal diverticulum by performing a minimally invasive laparoscopic transhiatal resection and Heller myotomy with Dor fundoplication after observing its enlargement on radiological and endoscopic examinations over 2 years. We believe laparoscopic transhiatal resection and Heller myotomy with Dor fundoplication may therefore become the standard treatment modality for minimally invasive surgery for esophageal epiphrenic diverticulum.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Minim Access Surg
                Journal ID (iso-abbrev): J Minim Access Surg
                Journal ID (publisher-id): JMAS
                Title: Journal of Minimal Access Surgery
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0972-9941
                ISSN (Electronic): 1998-3921
                Publication date (Print): Oct-Dec 2022
                Publication date (Electronic): 15 November 2021
                Volume: 18
                Issue: 4
                Pages: 616-618
                Affiliations
                [1 ]Department of Trauma and Emergency (General Surgery), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
                [2 ]Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
                [3 ]Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
                Author notes
                Address for correspondence: Dr. Satya Prakash Meena, Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. E-mail: drsatyaprakash04@ 123456gmail.com
                Article
                Publisher ID: JMAS-18-616
                DOI: 10.4103/jmas.jmas_195_21
                PMC ID: 9632702
                PubMed ID: 35046175
                SO-VID: 91893e5b-7c57-481e-b181-310d1216425c
                Copyright © Copyright: © 2021 Journal of Minimal Access Surgery
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 13 June 2021
                Date revision received : 23 September 2021
                Date accepted : 23 September 2021
                Categories
                Subject: Unusual Case

                ScienceOpen disciplines: Surgery
                Keywords: endoscopy,epiphrenic diverticulum,laparoscopy,minimal access surgery,oesophagus,thoracotomy
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: endoscopy, epiphrenic diverticulum, laparoscopy, minimal access surgery, oesophagus, thoracotomy

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