Laparoscopic transhiatal treatment of esophageal diverticula in an epiphrenic location

doi:10.3877/cma.j.issn.2095-8773.2020.03.03

Abstract

Abstract:

Objective

To investigate the feasibility and effectiveness of laparoscopic minimally invasive treatment of epiphrenic diverticula.

Methods

Thirty-one patients with esophageal diverticula treated in Shanghai Chest Hospital from January 2015 to June 2020 were retrospectively analyzed, including 13 cases of epiphrenic diverticula. Preoperative diagnostic examinations included barium esophagram, upper gastrointestinal endoscopy, 24-hour esophageal pH monitoring and manometry. Cases 1-2 were performed via a left thoracotomy, Case 3 via a right thoracoscope, and Cases 4-13 via a laparoscopic hiatus. Postoperative observation indexes included operation related complications and symptom relief.

Results

Among the 13 cases, 7 (53.8%) were male, and the age was (64.08±5.9) years. The diverticula in 10 cases (76.9%) were oriented to the left esophageal wall. The distance between the diverticulum neck and the incisor teeth was (35.8±2.0) cm, and the diameter of the diverticulum was (4.5±1.7) cm. The operation time was (122.1±45.7) min, the blood loss was (115.4±60.5) mL, and the hospital stay was (10.0±3.4) days. The esophageal fistula occurred in 3 cases postoperatively, including 1 case via a left thoracotomy (50%) , 1 case via a right thoracoscope (100%) and 1 case via a transabdominal (10%) pathway. Two cases with esophageal fistula needed reoperation. There was no in-hospital mortality. Long-term follow-up showed that 1 patient had esophageal stenosis after left thoracic pathway, 1 patient had reflux after right thoracic pathway, and 2 patients had esophageal stenosis after laparoscopic surgery.

Conclusion

Laparoscopic transhiatal treatment of epiphrenic diverticula can greatly improve the safety of the operation and reduce the possibility of postoperative fistula and recurrence of diverticula by relieving the distal obstruction.

Key words: Epiphrenic diverticula, Esophageal motor dysfunction, Laparoscopic minimally invasive surgery, Heller myotomy, Fundoplication

Haoyao Jiang, Yu Yang, Yifeng Sun, Rong Hua, Xufeng Guo, Zhigang Li. Laparoscopic transhiatal treatment of esophageal diverticula in an epiphrenic location[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2020, 07(03): 140-145.

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Figures/Tables 6

References 19

1	Duda M, Serý Z, Vojácek K，et al．Etiopathogenesis and classification of esophageal diverticula[J]．Int Surg，1985，70(4):291-295.
2	Tobin RW．Esophageal rings，webs，and diverticula[J]．J Clin Gastroenterol，1998，27(4):285-295.
3	Thomas ML, Anthony AA, Fosh BG，et al．Oesophageal diverticula[J]．Br J Surg，2001，88(5):629-642.
4	Fasano NC, Levine MS, Rubesin SE，et al．Epiphrenic diverticulum：clinical and radiographic findings in 27 patients[J]．Dysphagia，2003，18(1):9-15.
5	Nehra D, Lord RV, DeMeester TR，et al．Physiologic basis for the treatment of epi-phrenic diverticulum[J]．Ann Surg，2002，235(3):346-354.
6	D’Journo XB, Ferraro P, Martin J，et al．Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum[J]．Br J Surg，2009，96(8):892-900.
7	Benacci JC, Deschamps C, Trastek VF，et al．Epiphrenic diverticulum：results of surgical treatment[J]．Ann Thorac Surg，1993，55(5):1109-1113; discussion 1114.
8	Hudspeth DA, Thorne MT, Conroy R，et al．Management of epiphrenic esophageal diverticula．A fifteen-year experience[J]．Am Surg，1993，59(1):40-42.
9	Rosati R, Fumagalli U, Bona S，et al．Laparoscopic treatment of epiphrenic diver-ticula[J]．J Laparoendosc Adv Surg Tech A，2001，11(6):371-375.
10	Fraiji E Jr, Bloomston M, Carey L，et al．Laparoscopic management of symptomat-ic achalasia associated with epiphrenic diverticulum[J]．Surg Endosc，2003，17(10):1600-1603.
11	Tedesco P, Fisichella PM, Way LW，et al．Cause and treatment of epiphrenic diver-ticula[J]．Am J Surg，2005，190(6):891-894.
12	Altorki NK, Sunagawa M, Skinner DB．Thoracic esophageal diverticula．Why is operation necessary?[J]．J Thorac Cardiovasc Surg，1993，105(2):260-264.
13	Rosati R, Fumagalli U, Bona S，et al．Diverticulectomy，myotomy，and fundoplica-tion through laparoscopy：a new option to treat epiphrenic esophageal diverticula?[J]．Ann Surg，1998，227(2):174-178.
14	Streitz JM Jr, Glick ME, Ellis FH Jr．Selective use of myotomy for treatment of ep-iphrenic diverticula．Manometric and clinical analysis[J]．Arch Surg，1992，127(5):585-587;discussion 587-588.
15	Palanivelu C, Rangarajan M, John SJ，et al．Laparoscopic transhiatal approach for benign supra-diaphragmatic lesions of the esophagus：a replacement for thoraco-scopy?[J]．Dis Esophagus，2008，21(2):176-180.
16	Fernando HC, Luketich JD, Samphire J，et al．Minimally invasive operation for esophageal diverticula[J]．Ann Thorac Surg，2005，80(6):2076-2080.
17	Allaix ME, Borraez Segura BA, Herbella FA，et al．Is resection of an esophageal epiphrenic diverticulum always necessary in the setting of achalasia?[J]．World J Surg，2015，39(1):203-207.
18	Westcott CJ, O'Connor S, Preiss JE，et al．Myotomy-First Approach to Epiphrenic Esophageal Diverticula[J]．J Laparoendosc Adv Surg Tech A，2019，29(6):726-729.
19	Andrási L, Paszt A, Simonka Z，et al．Laparoscopic Surgery for Epiphrenic Esophageal Diverticulum[J]．JSLS，2018，22(2):e2017.00093.

类型	例数	位置
颈段Zenker’s憩室	10	颈部
胸中段憩室	6	胸中段
隔上憩室	13	胸下段，1例多发
合并食管癌	2	胸中段

类型	例数	位置
颈段Zenker’s憩室	10	颈部
胸中段憩室	6	胸中段
隔上憩室	13	胸下段，1例多发
合并食管癌	2	胸中段

特征		结果
性别[n（%）]		?
?	男	7（53.8）
?	女	6（46.2）
年龄（岁）		64.08±5.9
憩室部位[n（%）]		?
?	左壁	10（76.9）
?	右壁	3（23.1）
憩室距门齿距离（cm）		35.8±2.0
憩室直径（cm）		4.5±1.7

特征		结果
性别[n（%）]		?
?	男	7（53.8）
?	女	6（46.2）
年龄（岁）		64.08±5.9
憩室部位[n（%）]		?
?	左壁	10（76.9）
?	右壁	3（23.1）
憩室距门齿距离（cm）		35.8±2.0
憩室直径（cm）		4.5±1.7

特征		结果
手术方式[n（%）]		?
?	左胸开放	2（15.4）
?	右胸腔镜	1（7.7）
?	腹腔镜	10（76.9）
手术时间（min）		122.1±45.7
失血量（mL）		115.4±60.5
住院天数（天）		10.0±3.4
二次手术[n（%）]		2（15.4）
术后瘘[n（%）]		3（23.1）

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