Laparoscopic management of gastric diverticula

Gastric diverticular are rare and usually are diagnosed incidentally on rad iographic examination. Surgical treatment, consisting of simple excision or inversion of the diverticulum, has been reserved for patients with proven symptoms or complications. These procedures have typically required laparot omy, but with the development of advanced endoscopic techniques, a minimall y invasive approach may be appropriate. The authors report two cases of gas tric diverticula managed laparoscopically and review the literature related to this entity. Between 1993 and 1996, two patients were evaluated for dys pepsia-like gastrointestinal complaints. Both patients were found to have a gastric diverticulum on a contrast study, and one diverticulum was also se en on upper endoscopy. Laparoscopic resection was undertaken in both cases. Flexible gastroscopy was performed intraoperatively to help localize the d iverticulum, which was resected with an endoscopic stapling device. Nissen fundoplication was performed in conjunction with the diverticulectomy in th e second patient for gastroesophageal reflux. Both procedures were complete d laparoscopically without complications. The postoperative course was unev entful in both patients. At long-term follow-up, the patients are asymptoma tic. This experience indicates that laparoscopic resection of symptomatic g astric diverticula is a feasible alternative to laparotomy. A prospective a nalysis to verify the safety and efficacy of this procedure should be done.