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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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Endoscopic diverticulostomy of a Zenker-diverticulum with argon plasma coagulation a) at first session, b) just before second session, c) after third session.
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Figure 4: Endoscopic diverticulostomy of a Zenker-diverticulum with argon plasma coagulation a) at first session, b) just before second session, c) after third session.

Mentions: The clear exposure of the diverticle's neck allows a safe and efficient resection but dividing the cricopharyngeus muscle fibres also constitutes a crucial step in the treatment of a Zenker's diverticle. The endoluminal approach using rigid laryngoscopes has become the predominant surgical technique [3]. Minimally invasive endoluminal approaches encompass both endoscopic stapling of the esophageal wall and fibre-optic treatment. Both techniques imply a diverticulostomy together with a myotomy. Using an endostapler it is possible to dissect the septum between the lumen of the esophagus and the diverticle. Simultaneously, the anterior wall of the diverticulum and the posterior wall of the esophagus are sealed with a double stapling line. Other principle techniques to dissect the septum are needle-knife incision [17], argon plasma coagulation [18] (Figure 4) and monopolar coagulation [19]. Usually, to complete the diverticulostomy requires two to five sessions according to size of the diverticulum. There are no randomized trials comparing the different approaches and the endoscopist's choice of technique is based upon experience and preference.


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)

Endoscopic diverticulostomy of a Zenker-diverticulum with argon plasma coagulation a) at first session, b) just before second session, c) after third session.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 4: Endoscopic diverticulostomy of a Zenker-diverticulum with argon plasma coagulation a) at first session, b) just before second session, c) after third session.
Mentions: The clear exposure of the diverticle's neck allows a safe and efficient resection but dividing the cricopharyngeus muscle fibres also constitutes a crucial step in the treatment of a Zenker's diverticle. The endoluminal approach using rigid laryngoscopes has become the predominant surgical technique [3]. Minimally invasive endoluminal approaches encompass both endoscopic stapling of the esophageal wall and fibre-optic treatment. Both techniques imply a diverticulostomy together with a myotomy. Using an endostapler it is possible to dissect the septum between the lumen of the esophagus and the diverticle. Simultaneously, the anterior wall of the diverticulum and the posterior wall of the esophagus are sealed with a double stapling line. Other principle techniques to dissect the septum are needle-knife incision [17], argon plasma coagulation [18] (Figure 4) and monopolar coagulation [19]. Usually, to complete the diverticulostomy requires two to five sessions according to size of the diverticulum. There are no randomized trials comparing the different approaches and the endoscopist's choice of technique is based upon experience and preference.

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