Laparoscopic Transhiatal Resection of Esophageal Diverticulum

Introduction: Mid-esophageal diverticulum is often associated with a concomitant esophageal motility disorder. The treatment consists of esophagomyotomy in addition to excision of the diverticulum. In patients with mid-esophageal diverticulum, the laparoscopic approach is less well accepted.
Methods: We present a video of a 78 year old female with a long history of regurgitation, intermittent dysphagia and recent onset hiccups. Upper GI series revealed an esophageal diverticulum reportedly close to the hiatus. Due to the location, the diverticulum was resectable through either the chest or the abdomen. This video demonstrates the laparoscopic transhiatal approach for resection of the diverticulum with esophagomyotomy.
Results: The procedure was completed laparoscopically using upper endoscopy to inflate the diverticulum, collapsed and virtually invisible because of the positive pneumoperitoneal pressure. The diverticulum was located in the mid-esophagus at the level of the inferior pulmonary vein. Widening the hiatus by incising its apex improved exposure in the mediastinum facilitating more accurate placement of an endoscopic GIA stapler to divide the diverticular neck. Esophagomyotomy was performed on the side of the esophagus opposite the diverticulum. The hiatus was repaired and an anterior fundoplication was performed to optimize post-operative esophageal function. In the post-operative period the dysphagia and the regurgitation resolved, but the hiccups persisted.
Conclusion: This video demonstrates that the laparoscopic transhiatal approach is safe and feasible in the resection of a mid-esophageal diverticulum.

Session: Video Channel

Program Number: V079

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