Andrew J Fritze, MD, Michael Latzko, MD, Ziad Awad, MD, FACS, Bestoun Ahmed, MD, FACS, FRCS, FASASMBS. University of Florida College of Medicine Jacksonville
Esophageal diverticulum is a relatively rare entity that is typically classified according to its location and etiology. Pharyngoesophageal (Zenker’s) diverticula occur between the muscle fibers of the thyropharyngeus and cricopharyngeus. Epiphrenic diverticula occur in the distal third of the esophagus and are mucosal outpouchings that are thought to be pulsion diverticula related to increased pressure zones in the esophagus. Mid-esopahgeal diverticula are typically located within 5 cm of the carina and are most-commonly thought to be traction diverticula related to lymphadenopathy and inflammatory processes. Although often asymptomatic and therefore frequently undetected the management of symptomatic esophageal diverticula is controversial. The difficulty is primarily due to our incomplete understanding of the patholophysiology of this disease process and the inherent risks of operative resection. Minimally invasive management of this complex process has been established as the preferred approach by most authors.
We present our experience with right video-assisted thoracoscopic management of a mid-esophageal diverticulum. A 75 year old female with a history of reflux and hiatal hernia presented with dysphagia and regurgitation of undigested food and pills. An EGD revealed a large mid-esophageal diverticulum containing undigested food. A barium esophagram demonstrated a right mid-esophageal diverticulum approximately 6x3x4cm in size. Thoracoscopic esophageal myotomy and resection of this diverticulum over a 56-French bougie was successfully performed. The patient had an uncomplicated post-operative course and was discharged on day three. At two year follow-up the patient had complete relief of dysphagia and regurgitation. As demonstrated by this case, minimally invasive management of mid-esophageal diverticula is feasible and safe and should at minimum involve a long esophagomyotomy along with resection of the diverticulum.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79788
Program Number: V109
Presentation Session: Friday Exhibit Hall Video Presentations Session 3 (Non CME)
Presentation Type: EHVideo