Laparoscopic enucleation of a horseshoe-shaped leiomyoma of the lower esophagus

Demetrio Cavadas, MD, Roberto E Remolo, MD, Alfredo Amenabar, MD, Agustin Duro, MD, Fernando G Wright, MD, Axel F Beskow, MD

Hospital Italiano de Buenos Aires

Esophageal leiomyomas are rare benign tumors that represent 0,4-1% of all esophageal lesions. The most frequently found symptom is dysphagia. In the treatment of these tumors, enucleation should always be attempted in order to avoid an esophagectomy. This video shows a 61 year old male who presented with dysphagia that started 2 months before and weight loss of 11 lbs. An esophagogastroduodenoscopy, barium swallow, endoscopic ultrasound and computed tomography with distension technique were done, showing a large submucosal tumor of the lower esophagus, proximal to the gastroesophageal junction (GEJ). A laparoscopic approach was decided, although a thoracoscopy could not be ruled out due to the tumor’s large size and proximal extension. A conventional 4 port placement and a Nathanson liver retractor were used, as usually done to approach the hiatal region. After dissecting the GEJ and the lower mediastinum, the large tumor was identified and enucleated. The anterior vagus was preserved. The opened esophageal muscular layers were closed. Intraoperative endoscopic control was done during the whole surgery, allowing to precisely identify the tumor and detect any potential mucosal tear. The patient did well and was discharged on postoperative day 2, after a barium swallow that showed no leaks and good esophageal clearance.
Esophageal horseshoe leiomyomas are rare tumors that, although benign, could lead to an esophagectomy. The enucleation, when possible, is the treatment of choice.

Session: Podium Presentation

Program Number: V020

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