title: Minimally invasive management of epiphrenic esophageal diverticula.
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.
authors.affiliation: Department of General Surgery, Carolina's Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
authors.forename: Brent D
authors.initials: BD
authors.lastname: Matthews
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Nelms
authors.forename: Charles E
authors.initials: CE
authors.lastname: Lohr
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Harold
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D003938:Diagnostic Techniques, Digestive System; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004936:Diverticulum, Esophageal / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies