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Ann Thorac Surg 2005;80:2076-2080
© 2005 The Society of Thoracic Surgeons

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Original article: General thoracic

Minimally Invasive Operation for Esophageal Diverticula

Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Accepted for publication June 3, 2005.

^_* Address correspondence to Dr Fernando, Cardiothoracic Surgery, Boston Medical Center, 88 East Newton Street, Robinson B402, Boston, MA 02118 (Email: hiran.fernando{at}bmc.org).

BACKGROUND: Mid and lower esophageal diverticula are rare entities usually managed by open operation. Morbidity can be significant with these complex procedures. This study evaluates our results of minimally invasive surgery for esophageal diverticula.

METHODS: Over a 5-year period, 20 patients underwent operation for esophageal diverticula. Median age was 70.5 years. There were 16 epiphrenic and 4 midesophageal diverticula with a median size of 7.5 cm (range, 2-11 cm). Symptoms included dysphagia (14), regurgitation (12), weight loss (8), heartburn (4), aspiration pneumonia (3), chest pain (2), and vomiting (2). Dysphagia scores (1 = none, 5 = severe) were recorded before and after operation.

RESULTS: Surgical approaches were laparoscopy (10), video-assisted thoracic surgery (VATS) (7), laparoscopic/VATS (2), and laparoscopic/thoracotomy (1). The most common operation performed was a diverticulectomy, myotomy, and partial fundoplication (12). Complications occurred in 9 (45%) patients and included 4 (20%) esophageal leaks. Three leak patients had successful outcomes; the fourth patient died 61 days after operation. Median hospital stay was 5.0 (1–61) days. Detailed follow-up was available in 18 patients at a median of 15 (1–70) months. Dysphagia scores improved significantly (p < 0.001) from 2.3 to 1.3 postoperatively. Symptomatic improvement was excellent in 13 (72%), good in 2 (11%), fair in 1 (6%), and poor in 2 (11%) patients.

CONCLUSIONS: Minimally invasive operations for esophageal diverticula are feasible but also challenging. The potential for morbidity is significant. Patients should be selected and evaluated carefully before undertaking repair. Open surgery should remain the standard except in centers experienced with minimally invasive esophageal surgery.

This article has been cited by other articles:

				T. K. Varghese Jr, B. Marshall, A. C. Chang, A. Pickens, C. L. Lau, and M. B. Orringer Surgical Treatment of Epiphrenic Diverticula: A 30-Year Experience Ann. Thorac. Surg., December 1, 2007; 84(6): 1801 - 1809. [Abstract] [Full Text] [PDF]

				J. M. Streitz Jr Invited commentary Ann. Thorac. Surg., December 1, 2005; 80(6): 2080 - 2081. [Full Text] [PDF]