title: Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum.
abstract: BACKGROUND
  We evaluated outcome after laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication.
  
  
  METHODS
  Patients with symptomatic achalasia and epiphrenic diverticula underwent laparoscopic diverticulectomy, Heller myotomy, and partial fundoplication. Intraoperative endoscopy and postoperative esophagography were performed in all patients. Patients graded preoperative and postoperative dysphagia and heartburn on a Likert scale.
  
  
  RESULTS
  Anterior fundoplication was performed in five patients and posterior fundoplication in one. Mean follow-up was 9 months (range, 1-17 months). One intraoperative complication occurred--an esophagotomy that was laparoscopically repaired. There were no postoperative leaks. Patient-reported dysphagia decreased from 4.5 +/- 0.8 (mean +/- SD) to 1.8 +/- 1.7 ( p < 0.05 matched pair analysis). Heartburn decreased from 4.3 +/- 0.8 to 1.3 +/- 1.3 ( p < 0.05). All patients reported improvement in symptoms after operation.
  
  
  CONCLUSIONS
  Laparoscopic esophageal diverticulectomy, Heller myotomy, and partial fundoplication with intraoperative endoscopy safely reduce dysphagia associated with achalasia and esophageal diverticula while limiting symptoms of gastroesophageal reflux.
authors.affiliation: Department of Surgery, University of South Florida, and Tampa General Hospital, Post Office Box 1289, Room F145, Tampa, FL 33601, USA.
authors.forename: E
authors.initials: E
authors.lastname: Fraiji
authors.forename: M
authors.initials: M
authors.lastname: Bloomston
authors.forename: L
authors.initials: L
authors.lastname: Carey
authors.forename: E
authors.initials: E
authors.lastname: Zervos
authors.forename: S
authors.initials: S
authors.lastname: Goldin
authors.forename: M
authors.initials: M
authors.lastname: Banasiak
authors.forename: M
authors.initials: M
authors.lastname: Wallace
authors.forename: A S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000328:Adult; D000368:Aged; D004936:Diverticulum, Esophageal / Q000150:complications* / Q000601:surgery*; D004931:Esophageal Achalasia / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control; D006356:Heartburn / Q000209:etiology / Q000517:prevention & control; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010166:Palliative Care; D011446:Prospective Studies; D012008:Recurrence