Minimally invasive management of epiphrenic esophageal diverticula

Brent D. Matthews, Cynthia D. Nelms, Charles E. Lohr, Kristi L. Harold, Kent W. Kercher, B. Todd Heniford

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

The purpose of this study is to review our initial experience with a minimally invasive approach to manage symptomatic epiphrenic esophageal diverticula. Five patients with symptomatic epiphrenic esophageal diverticula underwent surgical management between August 1997 and December 2002. All patients complained of dysphagia; had experienced symptoms for at least 12 months; and were evaluated preoperatively by a barium esophagram, esophagogastroduodenoscopy, and esophageal manometry. The epiphrenic esophageal diverticula measured 5 cm or less in all patients. Manometry demonstrated esophageal dysmotility in three patients. A minimally invasive technique was completed in all five patients. Four patients underwent laparoscopic diverticulectomy and myotomy including a concomitant Toupet fundoplication, and one patient underwent thoracoscopic diverticulectomy and myotomy. The mean operative time was 245 minutes (range 175-334). The longest operative time was for the thoracoscopic procedure. The estimated blood loss was minimal (range 30-100 cm3). The laparoscopic patients had a mean postoperative length of stay of 2.75 days (range 2-4) and the patient undergoing a thoracoscopic approach was discharged on postoperative day 6 due to a history of lung disease and home oxygen requirements. There were no other postoperative complications. After a mean follow-up of 16.2 months (range 3-36) all patients are asymptomatic. Short-term follow-up after our initial experience with minimally invasive approaches for epiphrenic esophageal diverticula demonstrates that thoracoscopic and laparoscopic approaches are feasible; safe; and effectively alleviate dysphagia, regurgitation, and other associated symptoms. Long-term outcomes should be monitored during the evolution of these novel minimally invasive techniques to ensure outcomes comparable to those of a transthoracic open approach.

Original languageEnglish (US)
Pages (from-to)465-470
Number of pages6
JournalAmerican Surgeon
Volume69
Issue number6
StatePublished - Dec 1 2003

ASJC Scopus subject areas

  • Surgery

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    Matthews, B. D., Nelms, C. D., Lohr, C. E., Harold, K. L., Kercher, K. W., & Heniford, B. T. (2003). Minimally invasive management of epiphrenic esophageal diverticula. American Surgeon, 69(6), 465-470.