Diverticulectomy, myotomy, and fundoplication through laparoscopy: a new option to treat epiphrenic esophageal diverticula?
OBJECTIVE
To describe the technique and the results of laparoscopic diverticulectomy combined with esophageal myotomy and antireflux wrap for epiphrenic diverticula of the esophagus.


BACKGROUND
The epiphrenic diverticulum of the esophagus is a rare disease probably caused by a longstanding impairment of the esophageal motor activity. Although there is almost universal agreement to operate only on symptomatic patients, the optimal treatment is controversial. The best-accepted guideline is to treat the underlying motor disorder. This is generally done through a left thoracotomic approach that allows diverticulectomy, esophageal myotomy, and partial fundoplication.


METHODS
From January 1994 through February 1996, 4 patients underwent laparoscopic transhiatal diverticulectomy, esophageal myotomy, and partial fundoplication at our institution. A thorough preoperative study was done with barium swallow, esophagoscopy, and manometry in all patients; 24-hour pH monitoring was done in one case.


RESULTS
No postoperative complications were observed. Short- and medium-term results are satisfactory.


CONCLUSIONS
No theoretical objection should be made to this approach, because the principle of treatment of the diverticular pouch and the underlying motor disorder and the prevention of reflux is respected. Longer follow-up and a wider series are mandatory to substantiate these initially favorable results.
Rosati
R
R
Istituto Clinico Humanitas-Milano, Division of General and Minimally Invasive Surgery, Milan, Italy.
Fumagalli
U
U
Bona
S
S
Bonavina
L
L
Peracchia
A
A
D004936:Diverticulum, Esophageal / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome