Robotic transhiatal excision of epiphrenic diverticula

Abstract

An epiphrenic oesophageal diverticulum is most commonly a pulsion diverticulum which develops consequent to protrusion of mucosa through the muscular wall of the distal oesophagus. Most of them are associated with underlying oesophageal motility disorders. The predominant symptoms are dysphagia with regurgitation, and sometimes retrosternal pain, if accompanied by spasm of the oesophagus. Surgical management is recommended for symptomatic patients. Traditional procedures include thoracotomy or laparotomy with excision of the diverticula, but these are associated with high morbidity. Laparoscopic approach is a safe treatment option associated with lesser morbidity. Here, we present a case of epiphrenic diverticulum which was treated by the robotic approach without any complication. There was also no associated motility abnormality in our case so fundoplication was not done. Robotic surgery is a useful tool while operating near the hiatus and gastro-oesophageal junction. We consider transhiatal robotic approach as a safe and easy approach for surgery of epiphrenic diverticulum.

An Epiphrenic Diverticulum with Previous Perforation Excised Laparoscopically

“…Symptoms like weight loss and melaena/hematemesis are considered worrisome and may indicate a malignant change. The other presentations may be due to compression of the surrounding structures [ 14 ]. The chances of developing complications during a lifetime in asymptomatic patients with ED are less than 10% [ 2 , 14 ].…”

Giant epiphrenic diverticulum: an unusual case from diagnosis to treatment

“…Usually, a myotomy is followed by a fundoplication to limit the post-operative reflux, which is observed in 9,5% of patients who received a Dor’s fundoplication, vs 48% after a partial fundoplication. 4 …”

Treatment of Giant Esophageal Epiphrenic Diverticulum Using Robotic-Assisted Surgery

“…However, there are still few reports of similar treatment using the robotic platform that results are expected to be close to better than laparoscopy. 5,9,[16][17][18][19][20][21] When performed properly, these procedures have a high success rate, with few associated complications. Mortality from surgical treatment varies between 0% -9% and morbidity, around 20%.…”