Laparoscopic trans-hiatal approach in a rare case of double giant epiphrenic diverticula: A case report

The transthoracic approach for esophageal diverticulectomy saves dissection but limits the amount of antireflux surgery that can be done. However, the laparoscopic trans-hiatal approach usually limits access to large diverticula located at the mid-thoracic level. We describe a 67-year-old Thai man who had two giant epiphrenic diverticula (ED) (11 × 7.6 cm and 3.2 × 3.4 cm). The highest part of the fundus of the larger ED was 12.6 cm above the hiatus. Preoperative esophageal manometry and an upper gastrointestinal study showed no obvious features of motility disorder. In addition, the clinical evaluation of the esophagogastroduodenoscopy revealed a hiatal hernia. Laparoscopic trans-hiatal esophageal diverticulectomy with intraoperative assessment by endoscopy was carried out. A partial wrap using Dor fundoplication was constructed without myotomy. There were no postoperative related complications. We believe that tailor-made operations in unusual cases can be safe using combined techniques to reduce postoperative morbidity.