Laparoscopic transhiatal resection of a large mid-esophageal diverticulum: a case report

Abstract

This is a description of transhiatal laparoscopic approach for mid-esophageal diverticulum. Traditionally mid-esophageal diverticula are approached by thoracotomy or thoracoscopy, with the laparoscopic technique being reserved for epiphrenic diverticula. A 78-year-old Caucasian female with a secondary dilatative ischemic cardiomyopathy presented with dysphagia, tenderness in the epigastrium and a considerable weight loss. A large mid-esophageal diverticulum was found on barium swallow and confirmed by CT scan. Underlying achalasia was recorded on manometry. The patient underwent diverticulectomy via transhiatal approach, followed by Heller myotomy and Dor fundoplication. Throughout the procedure auxiliary, esophagoscopic image was provided by interventional gastroenterologist due to a very narrow operating field and lack of orientation points. Based on our experience with this case, we propose transhiatal approach as a feasible alternative to thoracoscopy, in particular with patients who suffer from cardiac or pulmonary co-morbidities which make traditional techniques of high risk.

Benefits of laparoscopic trans‐hiatal approach with Heller–Dor surgery in a case of mid‐esophageal diverticulum

“…To the best of our knowledge, most cases undergoing surgery for an esophageal diverticulum in PubMed were diagnosed with epiphrenic diverticulum. Moreover, only two cases have been available on minimum invasive surgery for mid‐esophageal diverticula with esophageal motility, excluding the present case 8,9 . In each case, trans‐hiatal laparoscopic esophageal diverticulectomy with Heller–Dor surgery had been performed, with no recurrence having been observed.…”

“…Moreover, only two cases have been available on minimum invasive surgery for mid-esophageal diverticula with esophageal motility, excluding the present case. 8,9 In each case, trans-hiatal laparoscopic esophageal diverticulectomy with Heller-Dor surgery had been performed, with no recurrence having been observed. In the present case, the diverticulum was located 27 mm from the tracheal bifurcation, which was higher than in both the other cases.…”