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MIS approach for diverticula of the esophagus.

Laubert T, Hildebrand P, Roblick UJ, Kraus M, Esnaashari H, Wellhöner P, Bruch HP - Eur. J. Med. Res. (2010)

Bottom Line: Operating time was 205, 135 and 141 minutes.We performed intraoperative intraluminal endoscopy in all patients.There were no intraoperative complications and although no surgical complications occured postoperatively one patient developed pneumonia which advanced to sepsis and lethal multi organ failure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23552 Lübeck, Germany. tlaubert@googlemail.com

ABSTRACT

Purpose: diverticula of the esophagus represent a rare pathological entity. Distinct classifications of the disease imply different surgical concepts. Surgery should be reserved for symptomatic patients only. Minimally invasive surgery (MIS) for treatment of esophageal diverticula encompasses rigid and flexible intraluminal endoscopy, thoracoscopy and laparoscopy. We here give an overview on the pathogenesis of esophageal diverticula, the minimally invasive surgical techniques for treatment and the recent literature. Additionally, we present our own experience with MIS for midthoracic diverticula.

Methods: we analyzed the cases of patients who underwent MIS for midthoracic diverticula with regard to preoperative symptoms, perioperative and follow-up data.

Results: three patients (two female, one male, age 79, 78 and 59 years) received thoracoscopic surgery for midthoracic diverticula. All patients reported of dysphagia and regurgitation. In two patients pH-investigation showed pathological reflux but manometry was normal in all patients. Operating time was 205, 135 and 141 minutes. We performed intraoperative intraluminal endoscopy in all patients. There were no intraoperative complications and although no surgical complications occured postoperatively one patient developed pneumonia which advanced to sepsis and lethal multi organ failure. Upon follow-up the two patients did not have recurrent diverticula or a recurrence of previous symptoms.

Conclusions: surgery for diverticular disease of the esophagus has been associated with high rates of morbidity and mortality. Despite the lethal non-surgical complication we encountered, with regard to recent publications minimally invasive apporaches to treat patients with symptomatic esophageal diverticula entail lower rates of complications with better long term results in comparison to open surgery.

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Related in: MedlinePlus

Barium swallow of a patient with a peribronchial diverticulum (Patient No. 3) a) in a.p. view and b) in lateral view.
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Figure 1: Barium swallow of a patient with a peribronchial diverticulum (Patient No. 3) a) in a.p. view and b) in lateral view.

Mentions: Patients with symptoms suggestive for an esoph ageal diverticulum should undergo radiological, endoscopic and functional studies to verify the existence of a diverticulum, determine its location, rule out differential diagnoses and assess the extend of functional disorder. A barium swallow shows the location and size of a diverticulum with great accuracy and sensitivity (Figure 1) [16]. Endoscopy rules out other pathologies, most importantly malignancy and additional information such as diameter of the diverticulum's neck can be received. Furthermore, endoscopy can often distinguish obstructive from functional disorders.


MIS approach for diverticula of the esophagus.

Laubert T, Hildebrand P, Roblick UJ, Kraus M, Esnaashari H, Wellhöner P, Bruch HP - Eur. J. Med. Res. (2010)

Barium swallow of a patient with a peribronchial diverticulum (Patient No. 3) a) in a.p. view and b) in lateral view.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3351906&req=5

Figure 1: Barium swallow of a patient with a peribronchial diverticulum (Patient No. 3) a) in a.p. view and b) in lateral view.
Mentions: Patients with symptoms suggestive for an esoph ageal diverticulum should undergo radiological, endoscopic and functional studies to verify the existence of a diverticulum, determine its location, rule out differential diagnoses and assess the extend of functional disorder. A barium swallow shows the location and size of a diverticulum with great accuracy and sensitivity (Figure 1) [16]. Endoscopy rules out other pathologies, most importantly malignancy and additional information such as diameter of the diverticulum's neck can be received. Furthermore, endoscopy can often distinguish obstructive from functional disorders.

Bottom Line: Operating time was 205, 135 and 141 minutes.We performed intraoperative intraluminal endoscopy in all patients.There were no intraoperative complications and although no surgical complications occured postoperatively one patient developed pneumonia which advanced to sepsis and lethal multi organ failure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23552 Lübeck, Germany. tlaubert@googlemail.com

ABSTRACT

Purpose: diverticula of the esophagus represent a rare pathological entity. Distinct classifications of the disease imply different surgical concepts. Surgery should be reserved for symptomatic patients only. Minimally invasive surgery (MIS) for treatment of esophageal diverticula encompasses rigid and flexible intraluminal endoscopy, thoracoscopy and laparoscopy. We here give an overview on the pathogenesis of esophageal diverticula, the minimally invasive surgical techniques for treatment and the recent literature. Additionally, we present our own experience with MIS for midthoracic diverticula.

Methods: we analyzed the cases of patients who underwent MIS for midthoracic diverticula with regard to preoperative symptoms, perioperative and follow-up data.

Results: three patients (two female, one male, age 79, 78 and 59 years) received thoracoscopic surgery for midthoracic diverticula. All patients reported of dysphagia and regurgitation. In two patients pH-investigation showed pathological reflux but manometry was normal in all patients. Operating time was 205, 135 and 141 minutes. We performed intraoperative intraluminal endoscopy in all patients. There were no intraoperative complications and although no surgical complications occured postoperatively one patient developed pneumonia which advanced to sepsis and lethal multi organ failure. Upon follow-up the two patients did not have recurrent diverticula or a recurrence of previous symptoms.

Conclusions: surgery for diverticular disease of the esophagus has been associated with high rates of morbidity and mortality. Despite the lethal non-surgical complication we encountered, with regard to recent publications minimally invasive apporaches to treat patients with symptomatic esophageal diverticula entail lower rates of complications with better long term results in comparison to open surgery.

Show MeSH
Related in: MedlinePlus