title: Minimally invasive operation for esophageal diverticula.
abstract: BACKGROUND
  Mid and lower esophageal diverticula are rare entities usually managed by open operation. Morbidity can be significant with these complex procedures. This study evaluates our results of minimally invasive surgery for esophageal diverticula.
  
  
  METHODS
  Over a 5-year period, 20 patients underwent operation for esophageal diverticula. Median age was 70.5 years. There were 16 epiphrenic and 4 midesophageal diverticula with a median size of 7.5 cm (range, 2-11 cm). Symptoms included dysphagia (14), regurgitation (12), weight loss (8), heartburn (4), aspiration pneumonia (3), chest pain (2), and vomiting (2). Dysphagia scores (1 = none, 5 = severe) were recorded before and after operation.
  
  
  RESULTS
  Surgical approaches were laparoscopy (10), video-assisted thoracic surgery (VATS) (7), laparoscopic/VATS (2), and laparoscopic/thoracotomy (1). The most common operation performed was a diverticulectomy, myotomy, and partial fundoplication (12). Complications occurred in 9 (45%) patients and included 4 (20%) esophageal leaks. Three leak patients had successful outcomes; the fourth patient died 61 days after operation. Median hospital stay was 5.0 (1-61) days. Detailed follow-up was available in 18 patients at a median of 15 (1-70) months. Dysphagia scores improved significantly (p < 0.001) from 2.3 to 1.3 postoperatively. Symptomatic improvement was excellent in 13 (72%), good in 2 (11%), fair in 1 (6%), and poor in 2 (11%) patients.
  
  
  CONCLUSIONS
  Minimally invasive operations for esophageal diverticula are feasible but also challenging. The potential for morbidity is significant. Patients should be selected and evaluated carefully before undertaking repair. Open surgery should remain the standard except in centers experienced with minimally invasive esophageal surgery.
authors.affiliation: Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. hiran.fernando@bmc.org
authors.forename: Hiran C
authors.initials: HC
authors.lastname: Fernando
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: John
authors.initials: J
authors.lastname: Samphire
authors.forename: Miguel
authors.initials: M
authors.lastname: Alvelo-Rivera
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
authors.forename: Percival O
authors.initials: PO
authors.lastname: Buenaventura
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods; D004936:Diverticulum, Esophageal / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies