Laparoscopic approach for esophageal achalasia with epiphrenic diverticulum

We report the case of a 65-year-old woman with a 10-year history of dysphag ia, regurgitation, cough, and 10-kg weight loss caused by an epiphrenic div erticulum associated with esophageal achalasia managed with a laparoscopic approach. A preoperative barium swallow showed a dilated sigmoid esophagus with a 6-cm epiphrenic diverticulum. Esophageal manometry confirmed the abs ence of peristalsis in the esophageal body. We performed a laparoscopic div erticulectomy and a 7-cm distal esophageal myotomy with a Dor fundoplicatio n. The postoperative course was uneventful. On the third postoperative day a barium swallow showed no leak, and the patient started oral intake. She w as discharged home 5 days after the operation free of symptoms and tolerati ng a soft diet. Sixteen month after surgery, she was asymptomatic and had g ained 8 kg. A barium swallow showed a normal-size esophagus with regular em ptying. We reaffirm the feasibility, safety, and efficacy of the laparoscop ic diverticulectomy and distal myotomy with Dor fundoplication to manage ep iphrenic diverticula resulting from esophageal achalasia.