Minimally invasive operation for esophageal diverticula.
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.
Fernando
Hiran C
HC
Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. hiran.fernando@bmc.org
Luketich
James D
JD
Samphire
John
J
Alvelo-Rivera
Miguel
M
Christie
Neil A
NA
Buenaventura
Percival O
PO
Landreneau
Rodney J
RJ
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