An Epiphrenic Diverticulum with Previous Perforation Excised Laparoscopically

TL;DR

This paper describes a successful laparoscopic surgery for a rare oesophageal condition complicated by previous perforation.

Contribution

The paper presents a novel laparoscopic approach for resecting a large epiphrenic diverticulum with dense adhesions from prior perforation.

Findings

Laparoscopic transhiatal resection was safely performed despite dense adhesions from a previous perforation.

The procedure avoided thoracoscopic approaches and was associated with no complications in this case.

This case expands the feasibility of minimally invasive surgery for complex epiphrenic diverticula.

Abstract

An epiphrenic diverticulum (ED) is a rare pseudodiverticulum commonly located at the lower end of the oesophagus. Surgical treatment is only required in patients with worsening dysphagia or repeated chest infection due to microaspirations, and most patients are now treated with minimally invasive surgery (MIS) using the laparoscopic or thoracoscopic approach. Laparoscopic surgery is considered difficult in the presence of previous perforation of the diverticula owing to the intraperitoneal and mediastinal adhesions and is associated with an increased incidence of complications. We were able to perform a laparoscopic transhiatal resection safely on a patient who had a large ED with a wide neck and dense abdominal and mediastinal adhesions due to previous localized perforation.

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