Esophageal Manometric Characteristics and Outcomes for Laparoscopic Esophageal Diverticulectomy, Myotomy and Partial Fundoplication for Epiphrenic Diverticula

Introduction: The purpose of this study is to characterize the esophageal motor and lower esophageal sphincter (LES) abnormalities associated with epiphrenic esophageal diverticula and analyze outcomes for laparoscopic esophageal diverticulectomy, myotomy and partial fundoplication.
Methods: Endoscopic, radiographic, manometric and perioperative records for patients undergoing laparoscopic esophageal diverticulectomy, anterior esophageal myotomy and partial fundoplication from 8/99-9/06 were reviewed from an IRB-approved outcomes database. Data are given as mean ± SD.
Results: An esophageal body motor disorder and/or LES abnormalities were present in 11 patients with epiphrenic diverticula; 3 patients were characterized as achalasia, 1 had vigorous achalasia, 2 had diffuse esophageal spasm and 5 had a nonspecific motor disorder. Presenting symptoms included chest pain (4/13), dysphagia (13/13), and regurgitation (7/13). Three patients had previous Botox injections and 3 patients had esophageal dilatations. Laparoscopic epiphrenic esophageal diverticulectomy with an anterior esophageal myotomy was completed in 13 patients (M:F, 3:10) with a mean age of 67.6±4.2 years, BMI of 28.1±1.9 kg/m2 and ASA 2.2±0.1. Partial fundoplication was performed in 12/13 patients (Dor, n=2; Toupet, n=10). Four patients had a Type I and 1 patient had a Type III hiatal hernia requiring repair. Mean operative time was 210±15.1 minutes and mean LOS was 2.8±0.4 days. Two Grade II or higher complications occurred including one patient who was readmitted on postoperative day 4 with a leak requiring a thoracotomy, esophageal repair and gastrostomy/jejunostomy tubes. After a mean follow-up of 13.6±3.0 months (range, 3-36), 2 patients complain of mild solid food dysphagia and 1 patient requires a PPI for GERD symptoms.
Conclusions: The majority of patients with epiphrenic esophageal diverticula have esophageal body motor disorders and/or LES abnormalities. Laparoscopic esophageal diverticulectomy and anterior esophageal myotomy with partial fundoplication is an appropriate technique with acceptable short-term outcomes in symptomatic patients.

Session: Podium Presentation

Program Number: S003

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