Laproendoscopic single site oesophageal diverticulectomy

Abstract

Epiphrenic divericula are uncommon disorders of the lower oesophagus, which are symptomatic in only 15–20% of cases. The optimum treatment modality for such cases remains an oesophageal diverticulectomy with long myotomy with or without an antireflux operation. Recently, this is increasingly being done through the laparoscopic approach. Here we describe the first reported case of oesophageal diverticulectomy through the laparoendoscopic single site approach. A 57-year-old man presented to us with 6 months history of dysphagia and regurgitation. Patient was investigated with upper gastrointestinal (UGI) endoscopy, barium swallow, CECT chest and abdomen, oesophageal manometry and 24 hour pH study. He was diagnosed to have lower oesophageal diverticulum with mildly elevated pressure readings in manometric studies with normal peristalsis. Based on his symptoms, he was taken up for surgery. A laparoscopic transhiatal oesophageal diverticulectomy with myotomy was done through laparoendoscopic single site technique. The procedure lasted 160 min. There was no intraoperative complication. Gastrograffin study was done on postoperative day 2 following which he was started on liquids. He made an uneventful recovery and was discharged on fourth day. He remained asymptomatic on follow up. Oesophageal diverticulectomy is possible through laparoendoscopic single site approach if necessary expertise is available.

Laparoscopic approach in the treatment of large epiphrenic esophageal diverticulum.

“…However, this method is associated with up to 20% increased staple-line leakage and postoperative morbidity compared with the laparoscopic approach [ 3 , 7 ]. The laparoscopic approach to epiphrenic diverticula should be considered today as the surgical treatment of choice for most patients [ 12 , 18 , 19 ]. Technical factors support this choice, including better visualization of the esophagogastric junction, easier myotomy, performance of antireflux wrap and better alignment of the stapler cartridge to the longitudinal axis of the esophagus.…”

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

“…Recently, many authors report the laparoscopic transhiatal approach to epiphrenic diverticula as a satisfying alternative to thoracoscopy, both single port [ 9 ] and multiport [ 7 , 10 ] approach being described. The most significant benefit of this method is that it allows surgical resection parallel to and along with esophagus versus perpendicular in thoracoscopic approach, enabling easier stapler manipulation.…”