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Minimally invasive management of an epiphrenic diverticulum
We present the case of a 65-year-old gentleman who was referred to our department with long standing symptoms of dysphagia, reflux, and regurgitation. An esophagogastroduodenoscopy (EGD) was initially performed to evaluate his symptoms and showed food residue in the esophagus and a wide-necked epiphrenic diverticulum extending from 38 to 41cm with superficial ulceration within it. The esophagogastric junction was at 45cm and appeared tight, which was consistent with the appearance of achalasia. A subsequent barium swallow and manometric studies confirmed the endoscopic findings. A minimally invasive laparoscopic approach was adopted for trans-hiatal dissection and diverticulectomy. Heller’s myotomy combined with an anti-reflux procedure was also performed to deal with the underlying achalasia as the cause of this pulsion diverticulum. The patient’s postoperative recovery was uneventful with complete resolution of his symptoms.
WT Butt, M Arumugasamy
Surgical intervention
2 years ago
1176 views
60 likes
0 comments
08:19
Minimally invasive management of an epiphrenic diverticulum
We present the case of a 65-year-old gentleman who was referred to our department with long standing symptoms of dysphagia, reflux, and regurgitation. An esophagogastroduodenoscopy (EGD) was initially performed to evaluate his symptoms and showed food residue in the esophagus and a wide-necked epiphrenic diverticulum extending from 38 to 41cm with superficial ulceration within it. The esophagogastric junction was at 45cm and appeared tight, which was consistent with the appearance of achalasia. A subsequent barium swallow and manometric studies confirmed the endoscopic findings. A minimally invasive laparoscopic approach was adopted for trans-hiatal dissection and diverticulectomy. Heller’s myotomy combined with an anti-reflux procedure was also performed to deal with the underlying achalasia as the cause of this pulsion diverticulum. The patient’s postoperative recovery was uneventful with complete resolution of his symptoms.
Laparoscopic resection of an epiphrenic diverticulum
This video shows a laparoscopic resection of a large epiphrenic diverticulum and an esophageal myotomy with partial posterior fundoplication. Abdominal obesity as well as an accessory left hepatic artery originating from the left gastric artery make dissection of the right para-esophageal area difficult. An anterior phrenotomy as well as the posterior retro-esophageal dissection towards the aorta make dissection of the diverticulum possible. The upper limit of the diverticulum is strongly attached to the esophagus and the pleura, and its dissection is difficult. After complete dissection of the diverticulum and with the guidance of an intraoperative endoscopy, resection is performed. As it is believed that an underlying motility disorder is present, a distal esophageal myotomy and partial fundoplication is added. The postoperative course was uneventful and the patient has no remaining symptoms.
P Vorwald, M Posada, S Ayora González, D Cortés, M de Vega Irañeta, C Ferrero, ML Sánchez de Molina
Surgical intervention
4 years ago
987 views
21 likes
0 comments
16:35
Laparoscopic resection of an epiphrenic diverticulum
This video shows a laparoscopic resection of a large epiphrenic diverticulum and an esophageal myotomy with partial posterior fundoplication. Abdominal obesity as well as an accessory left hepatic artery originating from the left gastric artery make dissection of the right para-esophageal area difficult. An anterior phrenotomy as well as the posterior retro-esophageal dissection towards the aorta make dissection of the diverticulum possible. The upper limit of the diverticulum is strongly attached to the esophagus and the pleura, and its dissection is difficult. After complete dissection of the diverticulum and with the guidance of an intraoperative endoscopy, resection is performed. As it is believed that an underlying motility disorder is present, a distal esophageal myotomy and partial fundoplication is added. The postoperative course was uneventful and the patient has no remaining symptoms.