Minimally Invasive Surgery Combined With Peroperative Endoscopy for Symptomatic Middle and Lower Esophageal Diverticula

Abstract

Esophageal diverticula are rare, accounting for less than 5% of dysphagia cases. Midesophageal and epiphrenic esophageal diverticula account for about 30% of all esophageal diverticula. Traditionally, thoracotomy or laparotomy were the preferred approaches for surgical therapy. Recently, minimally invasive therapies have been described. We present our experiences of 12 patients with diverticula of the distal two-thirds of the esophagus. Thoracoscopic approach was used to treat midesophageal diverticula and a transhiatal approach was used for the epiphrenic diverticula. Peroperative endoscopy was used in all cases. Underlying causes were also simultaneously dealt with. According to our series, epiphrenic diverticula were more common; lateral wall being the most common location. Myotomy and fundoplication were done depending on the underlying disorder. We highlight the importance of peroperative endoscopy to accurately localize and determine extent of diverticulectomy. Males were more common than females and most patients were elderly. Postoperatively, 2 cases had complications and 1 patient had leak. The length of hospital stay was 3 to 23 days. Esophageal diverticula are rare conditions, and minimally invasive surgery is certainly feasible and effective in terms of reduced morbidity.