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Laparoscopic heller myotomy and dor fundoplication combined with laparoscopic diverticular introversion suturing for achalasia complicated by epiphrenic diverticulum: Report of a case

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Abstract

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 × 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.

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References

  1. Postlethwait RW, Seaiy WC. Diverticulosis of the esophagus. New York: Appleton-Century-Crofts; 1979. p. 118–151.

    Google Scholar 

  2. Klaus A, Hinder RA, Swain J, Achem SR. Management of epiphrenic diverticula. J Gastrointest Surg 2003;7:906–911.

    Article  PubMed  Google Scholar 

  3. Mainprize KS, Dehn TC. Laparoscopic management of pseudoachalasia, esophageal diverticulum, and benign esophageal stromal tumor. Dis Esophagus 2001;14:73–75.

    Article  CAS  PubMed  Google Scholar 

  4. Csendes P, Csendes A, Cortes C, Burgos AN. Evolutive radiological changes of the esophagus in patients with achalasia who did not receive treatment. Surg Today 2007;37:183–186.

    Article  PubMed  Google Scholar 

  5. Zelter AR, Chiocca JC, Salis GB, Mazure PA. Esophageal pathology associated with achalasia. Acta Gastroenterol Latinom 1982;12:23–32.

    CAS  Google Scholar 

  6. Thomas ML, Anthony AA, Fosh BG, Finch JG, Maddern GJ. Oesophageal diverticula. Br J Surg 2001;88:629–642.

    Article  CAS  PubMed  Google Scholar 

  7. Eubanks TR, Pellegrini CA. Minimally invasive treatment of esophageal diverticula. Semin Thorac Cardiovasc Surg 1999;11:363–369.

    CAS  PubMed  Google Scholar 

  8. Rosati R, Fumagalli U, Bona S, Bonavina L, Peracchia A. Diverticulectomy, myotomy, and fundoplication through laparoscopy: a new option to treat epiphrenic esophageal diverticula? Ann Surg 1998;227:174–178.

    Article  CAS  PubMed  Google Scholar 

  9. Muller A, Halbfass HJ. Laparoscopic esophagotomy without diverticular resection for treating epiphrenic diverticulum in hypertonic lower esophageal sphincter. Chirurg 2004;75:302–306.

    Article  CAS  PubMed  Google Scholar 

  10. Rasmussen PC, Jensen BS, Winther A. Oesophageal achalasia combined with epiphrenic diverticulum: a case report. Scand J Thorac Cardiovasc Surg 1998;22:81–82.

    Google Scholar 

  11. Dobashi Y, Goseki N, Inutake Y, Kawano T, Endou M, Nemoto T. Giant epiphrenic diverticulum with achalasia occurring 20 years after Heller’s operation. J Gastroenterol 1996;86:1124–1128.

    Google Scholar 

  12. Braghetto I, Cardemil G, Schwartz E, Valladares H, Rencoret G, Estay R, et al. Videothoracoscopic management of middle esophageal diverticulum with secondary bronchoesophageal fistula: Report of a case. Surg Today 2008;38:1124–1128.

    Article  PubMed  Google Scholar 

  13. Castrucci G, Porziella V, Granone PL, Picciocchi A. Tailored surgery for esophageal body diverticula. Eur J Cardiothorac Surg 1998;14:380–387.

    Article  CAS  PubMed  Google Scholar 

  14. Allen TH, Clagett OT. Changing concepts in the surgical treatment of pulsion diverticula of the lower esophagus. J Thorac Cardiovasc Surg 1965;50:455–462.

    CAS  PubMed  Google Scholar 

  15. Pitchford TJ, Price PD. Laparoscopic Heller myotomy with epiphrenic diverticulectomy. J Soc Laparosc Surg 2003;7:165–169.

    Google Scholar 

  16. Benacci JC, Deschamps C, Trastek VF, Allen MS, Daly RC, Pairolero PC. Epiphrenic diverticulum: result of surgical treatment. Ann Thorac Surg 1993;55:1109–1113.

    Article  CAS  PubMed  Google Scholar 

  17. Saw EC, McDonald TP, Kam NT. Video-assisted thoracoscopic resection of an epiphrenic diverticulum with esophagomyotomy and partial fundoplication. Surg Laparosc Endosc 1998;8:145–148.

    Article  CAS  PubMed  Google Scholar 

  18. Picciocchi A, Cardillo G, D’Ugo D, Castrucci G, Mascellari L, Granone P. Surgical treatment of achalasia: A retrospective comparative study. Surg Today 1993;23:855–859.

    Article  CAS  PubMed  Google Scholar 

  19. Fraiji E Jr, Bloomston M, Carey L, Zervos E, Goldin S, Banasiak M, et al. Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum. Surg Endosc 2003;17:1600–1603.

    Article  PubMed  Google Scholar 

  20. Feo CV, Zamboni P, Zerbinati A, Pansini GC, Liboni A. Laparoscopic approach for esophageal achalasia with epiphrenic diverticulum. Surg Laparosc Endosc Percutan Tech 2001;11:112–115.

    CAS  PubMed  Google Scholar 

  21. Tedesco P, Fisichella PM, Way LW, Patti MG. Cause and treatment of epiphrenic diverticula. Am J Surg 2005;190:891–894.

    Article  PubMed  Google Scholar 

  22. Chami Z, Fabre JM, Navarro F, Domerque J. Abdominal laparoscopic approach for thoracic epiphrenic diverticulum. Surg Endosc 1999;13:164–165.

    Article  CAS  PubMed  Google Scholar 

  23. Myers BS, Dempsey DT. Laparoscopic resection of esophageal epiphrenic diverticulum. J Laparoscopic Adv Surg Tech 1998;8:201–207.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Daisan Hospital, Jikei University School of Medicine, 4-11-1 Izumihoncho, Komae, Tokyo, 201-8601, Japan

    Masato Hoshino

  2. Department of Surgery, Kashiwa Hospital, Jikei University School of Medicine, Tokyo, Japan

    Nobuo Omura

  3. Department of Surgery, Jikei University School of Medicine, Tokyo, Japan

    Fumiaki Yano, Kazuto Tsuboi, Akira Matsumoto, Hideyuki Kashiwagi & Katsuhiko Yanaga

Authors
  1. Masato Hoshino
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  2. Nobuo Omura
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  3. Fumiaki Yano
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  4. Kazuto Tsuboi
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  5. Akira Matsumoto
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  6. Hideyuki Kashiwagi
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  7. Katsuhiko Yanaga
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Hoshino, M., Omura, N., Yano, F. et al. Laparoscopic heller myotomy and dor fundoplication combined with laparoscopic diverticular introversion suturing for achalasia complicated by epiphrenic diverticulum: Report of a case. Surg Today 40, 158–161 (2010). https://doi.org/10.1007/s00595-009-4021-x

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  • DOI: https://doi.org/10.1007/s00595-009-4021-x

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