Achalasia Complicated By Epiphrenic Diverticulum Is Well Treated By Laparoscopic Diverticulectomy, Heller Myotomy, and Anterior Fundoplication

Introduction: An epiphrenic esophageal diverticulum is a consequence of severe long-standing achalasia and can further exacerbate the symptoms of achalasia. This study was undertaken to determine the operative complications and long-term outcomes after laparoscopic diverticulectomy, Heller myotomy, and anterior fundoplication for achalasia complicated by epiphrenic diverticulum.

Methods: Of 440 laparoscopic Heller myotomies, 25 patients have undergone laparoscopic diverticulectomy, Heller myotomy, and anterior fundoplication. Before and after operative intervention, patients scored the frequency/severity of symptoms utilizing a Likert scale (0=never/not bothersome to 10=always/very bothersome). Data are reported as median (mean +/-SD).

Results: Patient age was 73 years (68 years +/- 13.6); 52% of patients were male. Duration of preoperative symptoms was 5 years (7 years +/- 6.0). Preoperative dysphagia and regurgitation were particularly frequent and severe. After laparoscopic diverticulectomy, Heller myotomy, and anterior fundoplication, 14 patients experienced pleural effusion (5), capnothorax (4), gastrotomy (2), occult contrast extravasation at the staple line (2), and pneumonia (2). Length of stay was 2 days (4 days +/- 3.8). Follow-up is 35 months (37 months +/- 29.3). At last follow-up, dysphagia, choking, chest pain, vomiting and regurgitation had significant improved (p

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Program Number: P356

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