DIVERTICULECTOMY, MYOTOMY, AND FUNDOPLICATION THROUGH LAPAROSCOPY - ANEW OPTION TO TREAT EPIPHRENIC ESOPHAGEAL DIVERTICULA

Objective To describe the technique and the results of laparoscopic di verticulectomy combined with esophageal myotomy and antireflux wrap fo r epiphrenic diverticula of the esophagus. Summary Background Data The epiphrenic diverticulum of the esophagus is a rare disease probably c aused by a longstanding impairment of the esophageal motor activity. A lthough there is almost universal agreement to operate only on symptom atic patients, the optimal treatment is controversial. The best-accept ed guideline is to treat the underlying motor disorder. This is genera lly done through a left thoracotomic approach that allows diverticulec tomy, esophageal myotomy, and partial fundoplication. Methods From Jan uary 1994 through February 1996, 4 patients underwent laparoscopic tra nshiatal diverticulectomy, esophageal myotomy, and partial fundoplicat ion at our institution. A thorough preoperative study was done with ba rium swallow, esophagoscopy, and manometry in all patients; 24-hour pH monitoring was done in one case. Results No postoperative complicatio ns were observed. Short-and medium-term results are satisfactory. Conc lusions No theoretical objection should be made to this approach, beca use the principle of treatment of the diverticular pouch and the under lying motor disorder and the prevention of reflux is respected. Longer follow-up and a wider series are mandatory to substantiate these init ially favorable results.