Laparoscopic treatment of giant circumferential leiomyoma of the distal esophagus

Abstract

Introduction: Leiomyomas are rare esophagus tumors, with 0.4-1% incidence of all esophagus tumors. Only 5% grow to the point of being called giant tumors, measuring more than 10cm. Symptoms usually begin on tumors bigger than 5cm. Objective: Reporting a new therapeutic course of action to giant leiomyomas of distal esophagus. Case Report: VCA, female, 38 years old, presented retrosternal oppression for 4 months. Having realized a computed tomography on another service which demonstrated a mass suggestive of leiomyoma. On the endoscopy exam, performed for heartburn complaint and mild dysphagia, was determined a hiatal hernia of 2cm and mild gastritis. Patient submitted to complete excision of tumor without mucosal lesion and reconstruction of the external muscular wall, by the video laparoscopic method. Hiatoplasty and partial esophagogastrofundoplication were associated. The anatomic pathological examination confirmed leiomyoma, with 10x5x2cm. Patient evolved clinically without the appearance of the heartburn or dysphagia. With contrast examination of the esophagus after 6 months and endoscopy and tomography the following 4 years, all normal. The classic treatment of giant leiomyomas, includes thoracotomy with esophagectomy. Considering that in 80% of the cases it is found in the middle and lower thirds of the esophagus, the videolaparoscopic approach by transhiatal route becomes possible. The reconstruction of the external muscular layer is important to prevent a possible prolapse of the mucosa. Also, the realization of the fundoplication in addition to avoiding the gastroesophageal reflux, allows the suture area of the esophageal muscular wall to be covered, increasing the safety in the treatment. In services with experience in the surgical treatment of diseases of the gastric esophagus transition through the videolaparoscopic method, it is possible to perform with adequate safety the surgical treatment of the tumor lesions of the distal esophagus. The method provides greater postoperative comfort and prompt clinical surgical recovery.