Laparoscopic Enucleation of a Bronchogenic Cyst of Esophagus

Pablo Omelanczuk, Martin Berducci, P Gomez, MD, M Masrur, MD, J Nefa, MD

Division of General and Minimally Invasive Surgery, Department of Surgery, Italian Hospital of Mendoza, Mendoza, ARGENTINA

Introduccion: Bronchogenic cysts are rare bronchopulmonary foregut malformation. Intramural esophageal localization has been poorly reported in literature. The surgical resection is the only definitive treatment for most of these. A laparoscopic approach can be attempted in cysts located in the distal esophagus. This video highlight technical details of a laparoscopic enucleation of a bronchogenic cyst of the esophagus.

Methods: A 60 year old man with no significant medical history presented to clinic with a long-lasting gastroesophageal reflux. In the work up that included upper endoscopy and CT scan of Chest and abdomen the patient was diagnosed with a Cyst of the distal esophagus with benign characteristics. Due to the locations of the cyst patient was elected to undergo a laparoscopic enucleation.

Results: After pneumoperitoneo was achieved, a diagnostic laparoscopy was performed, reveling no intra-abdominal abnormality. Dissection was carried out around the Gastroesophageal junction. The hiatus was opened, dissecting the distal 10 cm of the esophagus into the mediastinum. The cyst of esophagus was identified and movilized completely into in the abdominal cavity. Using the harmonic device the cyst was dissected all around and removed from the muscle layer of esophagus.. An air leak test did not show any perforation on the mucosa. A closure of the myotomy was performed using a running absorbable suture. Then, a Nissen Fundoplication was performed using interrupted sutures. The fundoplication was secured to the right and left crus. A drain was left close to the myotomy. The operative time was 100 minutes. There were no intra- or post-operative complications. Patient was discharged on postoperative day 2. The pathology report informed unilocular bronchogenic cyst.

Conclusions: Laparoscopic enucleation of bronchogenic cyst of distal esophagus is a valid surgical therapeutic option. The minimally invasive approach allows for a complete cyst enucleation avoiding the necessity of large laparotomy, thoracotomy or thoraco-phreno-laparotomy.

Session: Podium Presentation

Program Number: V019

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