Robotic esophageal diverticulectomy with Heller myotomy and Dor fundoplication for giant epiphrenic diverticulum: a...

Epiphrenic esophageal diverticula are rare pulsion diverticula often associated with esophageal motility disorders. We report a 71-year-old man with a 7-year history of reflux, dysphagia, nocturnal regurgitation, and 12-kg weight loss over 8 months. Imaging revealed a 5 × 7 cm distal esophageal diverticulum, a 5-cm hiatal hernia, and findings suggestive of an esophageal motility disorder with a hypertensive lower esophageal sphincter. The patient underwent robotic diverticulectomy, Heller myotomy, hiatal hernia repair, and Dor fundoplication. Postoperative contrast study showed no leak, and he was discharged on Day 4. At 6-month follow-up, he remained asymptomatic with improved quality of life; the Gastroesophageal Reflux Disease - Health-Related Quality of Life (GERD-HRQL) score improved from 42 preoperatively to 18 at 30 days postoperatively. This case adds to the limited literature on robotic management of giant epiphrenic diverticula, illustrating that the robotic approach offers superior mediastinal visualization and that combined diverticulectomy with myotomy and fundoplication effectively addresses both anatomical and functional pathology.