Elizabeth H Bruenderman, MD, Farid J Kehdy, MD. University of Louisville
Background: This video reviews a laparoscopic esophageal diverticulectomy. The patient is an 80-year old lady who presented as an outpatient with dysphagia, pain with swallowing, chest pain, mild dyspepsia, hoarseness, and regurgitation of undigested food. She underwent a diagnostic esophagogram, which revealed an outpouching in the distal esophagus. Subsequent esophagogastroduodenoscopy (EGD) was consistent with an esophageal diverticulum in the distal third of the esophagus, along with a hiatal hernia and a benign stricture at the gastroesophageal junction. After appropriate preoperative workup, a laparoscopic diverticulectomy with Heller myotomy and hiatal hernia repair was performed.
Methods: After entry into the abdomen, the esophagus was dissected circumferentially at the hiatus and into the mediastinum, in order to mobilize the distal esophagus into the abdominal cavity. The diverticulum was noted at the one to two o’clock position on the esophagus. Care was taken to avoid the vagus nerve, particularly the anterior branch, which coursed along the anterior surface of the diverticulum. Intraoperative EGD was used to delineate the extent of the diverticulum, which was resected using a stapler over a 56-French bougie. A Heller myotomy was performed, and the crura were then re-approximated.
Results: Postoperative esophagogram was without evidence of leak or residual diverticulum. Her postoperative course was unremarkable, and she was discharged home on postoperative day two. On follow-up, her symptoms had resolved, and she was tolerating a regular diet.
Conclusion: Laparoscopic esophageal diverticulectomy can be performed both safely and effectively for diverticula located in the distal esophagus.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93973
Program Number: V261
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop