Laparoscopy as the initial approach for epiphrenic diverticula

Most epiphrenic diverticula traditionally have been approached through a left thoracotomy. Because laparoscopy provides excellent exposure to the distal esophagus and decreases the morbidity of thoracoscopy or thoracotomy, we have used it preferentially since 1997 and routinely since 2001. This study describes our experience with this approach.

From 1997 to 2008, 23 patients underwent surgery for epiphrenic diverticula at the University of Washington so that all patients are ≥2 years out. Our initial approach was via laparoscopy in 19 patients, VATS in 2, and open thoracotomy in 2. Details of the operation and postoperative course were recorded in our database. The patients were contacted by one of the investigators regarding current symptoms.

The median age was 57 (range 23-83) years. The medium follow-up was 45 months. Eighteen patients had esophageal manometry at our institution; 12 of them were abnormal (66.67%). The median diameter of diverticula was 4 (range 2-10) cm. From the 19 patients approached by laparoscopy, there was one conversion to open thoracotomy in a patient with an associated leiomyoma. Both patients approached by VATS were converted to thoracotomy. Patients initially approached by laparoscopy had a median length of stay of 3 days. There was one contained esophageal leak. One patient died within 30 days from complications of the operation. Ninety-two percent of patients reported improvement of their dysphagia and 77% improvement of regurgitation. None of the patients developed recurrent diverticula. Eighty-five percent of the patients rated the results of the operation as good or excellent.

Most epiphrenic diverticula can be treated successfully by using a laparoscopic approach. Morbidity and conversion rates are low and symptom control is excellent.