Laparoscopic approach in the treatment of large epiphrenic esophageal diverticulum.

Akerman

et al. 2017

Einstein (São Paulo)

Epiphrenic diverticulum is a rare disease associated with esophageal motor disorders that is usually asymptomatic and has a well-established surgical indication. We report a case of giant epiphrenic diverticulum in a 59-year-old symptomatic woman who was diagnosed after underwent complementary exams. Because of her symptoms, the surgical treatment was chosen, and esophageal diverticulectomy was performed along with laparoscopic cardiomyotomy and anterior partial fundoplication.

Section: Introductionmentioning

confidence: 99%

Giant esophageal epiphrenic diverticulum: presentation and treatment

Akerman

et al. 2017

Einstein (São Paulo)

“…Divertículos esofagianos, embora raros, devem sempre ser considerados como diagnóstico diferencial em casos de disfagia, halitose e enfermidades respiratórias por broncoaspiração (1) .Os divertículos de esôfago mais comuns são aqueles de pulsão, ou falsos divertículos, geralmente localizados no terço proximal ou no terço inferior, sendo comumente causados por aumento de pressão intra-esofagiana, secundário a distúrbios de motilidade ou obstrução.Por outro lado, divertículos de tração, ou divertículos verdadeiros, geralmente são pequenos, sintomáticos em até 20% dos pacientes e localizados a até dez centímetros da junção esôfago gástrica, estão presentesem homens 60-70 anos de idade,adquiridosecausados por sequelas de doenças pulmonares ou mediastinais (2) . Quando sintomáticos, os divertículos podem causar disfagia, regurgitação, halitose e rouquidão.…”

Section: Introductionunclassified

Divertículo Em Esôfago Proximal Secundário À Sequela De Tuberculose: Um Relato De Caso

Silva¹,

Patriarcha²,

Pereira³

et al. 2016

ACS

Conflito de interesses: NãoContribuição dos autores: RFGS concepção e planejamento, obtenção e interpretação de dados, redação do manuscrito. ALP obtenção e interpretação de dados, redação do manuscrito. RDDP obtenção e interpretação de dados, redação do manuscrito. ECJ interpretação de dados e revisão crítica. AAB interpretação de dados e revisão crítica. Contato para correspondência: Rodrigo Felipe Gongora e Silva E-mail: rodrigofelipegongora@hotmail. Resumo Introdução: Divertículos esofagianos, embora raros, devem sempre ser considerados como diagnóstico diferencial em casos de disfagia, halitose e enfermidades respiratórias por broncoaspiração. São classificados quanto à localização (proximal, médio, ou distal), à patogênese (pulsão ou tração) e à morfologia (verdadeiro ou falso). Nesse relato, apresentamos um caso de um divertículo de tração na parte proximal do esôfago, adquirido secundariamente à infecção por tuberculose no pulmão direito.Relatar causa rara de divertículo da parte proximal do esôfago.Relato de Caso:Revisão prontuário e pesquisa em banco de dados indexados em português e inglês. Mulher, 64 anos, em acompanhamento no ambulatório de cirurgia geral em virtude de megaesôfago chagásico, diagnosticado em novembro de 2014. Tomografia computadorizada apontou imagem sacular com nível hidroaéreo no mediastino superior, no terço médio do esôfago, que representa divertículo e está envolvido por processo fibrótico de lobo pulmonar superior direito. Assintomática e sem comemorativos ao exame físico, a paciente foi internada eletivamente para investigação etiológica. Relatou que aos 30 anos de idade foi diagnosticada com quadro de tuberculose pulmonar, sendo na época tratada por seis meses. Realizou-se endoscopia digestiva alta que apontou o mesmo divertículo da parte proximal do esôfago e levantou hipótese de etiologia por tração.Conclusão: Divertículos de tração são divertículos verdadeiros,resultados de contratura decorrente de processo inflamatório crônico envolvendo estruturas próximas à parede do esôfago. A maioria ocorre parte média do esôfago, causados por tuberculose e histoplasmose, com sintomas de disfagia ou com quadros de aspiração de repetição. A conduta adotada nesses casos é a excisão local do divertículo via toracotomia ou toracoscopia com tratamento concomitante da causa da inflamação crônica.Descritores: Divertículo Esofágico; Tuberculose; Transtornos da Deglutição.Abstract Introduction: Esophagus diverticulum should always be considered a differential diagnosis to dysphagia, halitosis, and respiratory diseases caused by aspiration.They are classified according to its location (proximal, medial or distal), pathogenesis (pulsion or traction) and to its morphology (true or false). In this case report, we present a case of a traction diverticulum in the proximal esophagussecondary to a tuberculosis (TB) infection on the right lung. Discuss a rare cause of a diverticulum in the proximal esophagus. Case Report:We carried out a review of patients' medical records, and a literature search was...

“…There are various options of surgical approaches for MIS such as VATS, laparoscopy or combined VATS and laparoscopy. According to previously published literatures, most surgeons preferred the laparoscopic approach (1,(3)(4)(5)7). Laparoscopic approach is useful for performing the myotomy across the LES and the antireflux procedure.…”

Section: A B Cmentioning

confidence: 99%

“…Recently, as the development of surgical techniques and instruments of minimally invasive surgery (MIS), many surgeons have attempted minimally invasive surgeries for epiphrenic esophageal diverticula. They reported that MIS for epiphrenic esophageal diverticula was a safe and feasible approach which had many advantages (1,(3)(4)(5)(6). There are various options of surgical approaches for MIS of epiphrenic diverticula such as video-assisted thoracoscopic approach, laparoscopy or combined thoracoscopy and laparoscopy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Single-port video-assisted thoracoscopic surgery for a huge epiphrenic esophageal diverticulum

Kang

2017

J. Thorac. Dis.

Epiphrenic esophageal diverticulum is uncommon disease, which is defined as the herniation of the mucosa and submucosa through the muscle layers of the esophageal wall in distal third of the esophagus.Traditionally, thoracotomy has been the preferred surgical approach. Recently, many surgeons have attempted minimally invasive surgeries for epiphrenic esophageal diverticula. They reported that minimally invasive surgery (MIS) for epiphrenic esophageal diverticula was a safe and feasible approach which had many advantages. There are various options of surgical approaches for MIS of epiphrenic diverticula. However, the best surgical approach remains uncertain. We report the case of a huge epiphrenic esophageal diverticulum, which was successfully treated by single-port video-assisted thoracoscopic surgery (VATS).Keywords: Esophageal diverticulum; minimally invasive surgical procedure; video-assisted thoracoscopic surgery J Thorac Dis 2017;9(1):E10-E13 jtd.amegroups.com general anesthesia with a double lumen endotracheal tube for one-lung ventilation. The patient was placed in a right decubitus position. The single incision (about 4 cm) was made in the left 6 th intercostal space on the mid-axillaryline. An X-small-sized wound retractor was applied for securing the intercostal space and 5 mm-30° thoracoscope was used (Figure 2). The esophagus and diverticulum were identified. There was no pleural adhesion and the diverticulum did not adhere to surrounding structures such as the lung, pericardium, diaphragm or aorta. The diverticulum was dissected away from the pleura and adherent muscle fiber avoiding mucosal perforation into the lumen with 5mm-endoscopic grasper, spatula-shaped electrocautery, and 5mm-endoscopic ultrasonic scalpel. The entire diverticular neck was exposed and divided with an endoscopic linear stapler The patient was maintained fasting for 6 days after the surgery. On the 6 th day after the surgery, an esophagogram with gastrografin was performed, which revealed that there was no stapler line leak and stenosis ( Figure 4). The patient resumed an oral diet 7 days after the surgery. The patient was discharged on postoperative day 8 without symptoms of dysphagia and regurgitation. The patient was followed up without recurrent disease for 6 months. DiscussionThere have been some controversies about whether the myotomy or the antireflux procedure should be performed in addition to the diverticulectomy in the surgical treatment for epiphrenic esophageal diverticula. Some authors reported that the routine myotomy across the LES and the antireflux procedure to decrease the risk of subsequent gastroesophageal reflux should be performed in every patient regardless the results of manometry, because most epiphrenic esophageal diverticula were associated with esophageal motility disorders (2,4). However, Rossetti et al. (1) and Macke et al. (7) reported that in patients with normal function of the LES, the myotomy across the LES is unnecessary. Therefore, the antireflux procedure is also not requir...