Laparoscopic Heller myotomy and Dor fundoplication combined with laparoscopic diverticular introversion suturing for achalasia complicated by epiphrenic diverticulum: report of a case.
A 41-year-old woman was admitted due to dysphagia and weight loss of 6 kg. An upper gastrointestinal radiographic contrast study demonstrated an S-shaped lower esophagus with a peak transverse diameter of 65 mm. Moreover, an epiphrenic diverticulum was also detected in the lower part of the esophagus (50 x 40 mm). The measurement of intraesophageal pressure showed a lower esophageal sphincter pressure of 80 mmHg and a lower esophageal sphincter length of 31 mm. Esophageal clearance assessment via a timed barium esophagogram demonstrated impaired contrast clearance, with a rate of 26% at 5 min. A laparoscopic Heller myotomy, Dor fundoplication, and diverticular introversion suturing were performed. The postoperative course was uneventful and the patient was discharged on day 4. At the 2-year follow-up, no dysphagia was present. This is the first report of a laparoscopic diverticuloplasty using an introversion buried suture with a Heller myotomy and Dor fundoplication for achalasia complicated by an epiphrenic diverticulum.
Hoshino
Masato
M
Department of Surgery, Daisan Hospital, Jikei University School of Medicine, 4-11-1 Izumihoncho, Komae, Tokyo, Japan.
Omura
Nobuo
N
Yano
Fumiaki
F
Tsuboi
Kazuto
K
Matsumoto
Akira
A
Kashiwagi
Hideyuki
H
Yanaga
Katsuhiko
K
D000328:Adult; D004936:Diverticulum, Esophageal / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D004931:Esophageal Achalasia / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011859:Radiography; D013536:Suture Techniques; D016896:Treatment Outcome