Myotomy-First Approach to Epiphrenic Esophageal Diverticula

Area of Science:

• Gastroenterology
• Surgical Innovation
• Esophageal Disorders

Background:

• Epiphrenic esophageal diverticula often require concurrent cardiomyotomy and diverticulectomy.
• Diverticulectomy can be technically challenging, leading to significant morbidity and a high staple line leak rate (up to 27%).
• Diverticula are frequently secondary to esophageal motility disorders like achalasia.

Purpose of the Study:

• To evaluate the efficacy of a laparoscopic myotomy-first strategy for epiphrenic esophageal diverticula.
• To assess symptom resolution and the need for subsequent diverticulectomy.
• To reduce morbidity associated with traditional diverticulectomy.

Main Methods:

• A retrospective review of 22 patients with epiphrenic diverticula treated between 2004 and 2018.
• Laparoscopic Heller myotomy and partial fundoplication were performed as the initial treatment.
• Diverticulectomy was reserved as a second-stage procedure for patients with persistent or recurrent symptoms.

Main Results:

• No perioperative complications were observed, with an average length of stay of 2.5 days.
• At a mean follow-up of 68 months, 77% of patients experienced resolution of dysphagia and 86% of regurgitation.
• Only 3 patients required further intervention; 2 underwent transthoracic diverticulectomy, and 1 had a per oral endoscopic myotomy, with mixed results.

Conclusions:

• A laparoscopic myotomy-first approach for epiphrenic diverticula is safe and effective.
• This strategy minimizes surgical risk and avoids unnecessary procedures.
• Laparoscopic Heller myotomy and partial fundoplication provide excellent symptom relief for the majority of patients.