Laparoscopic diverticulectomy with the aid of intraoperative gastrointestinal endoscopy to treat epiphrenic diverticulum

摘要

Objective: Most researchers believe that the presence of large epiphrenic diverticulum (ED) with severe symptoms should lead to theconsideration of surgical options. The choice of minimally invasive techniques and whether Heller myotomy with antireflux fundoplication should beemployed after diverticulectomy became points of debate. The aim of this study was to describe how to perform laparoscopic transhiataldiverticulectomy (LTD) and oesophagomyotomy with the aid of intraoperative gastrointestinal (GI) endoscopy and how to investigate whether theoesophagomyotomy should be performed routinely after LTD. Patients and Methods: From 2008 to 2013, 11 patients with ED underwentLTD with the aid of intraoperative GI endoscopy at our department. Before surgery, 4 patients successfully underwent oesophageal manometry:Oesophageal dysfunction and an increase of the lower oesophageal sphincter pressure (LESP) were found in 2 patients. Results: There were 2cases of conversion to an open transthoracic procedure. Six patients underwent LTD, Heller myotomy and Dor fundoplication; and 3 patientsunderwent only LTD. The dysphagia and regurgitation 11 patients experienced before surgery improved significantly. Motor function studiesshowed that there was no oesophageal peristalsis in 5 patients during follow-up, while 6 patients showed seemingly normal oesophageal motility.The LESP of 6 patients undergoing LTD, myotomy and Dor fundoplication was 16.7 ± 10.2 mmHg, while the LESPs of 3 patients undergoingonly LTD were 26 mmHg, 18 mmHg and 21 mmHg, respectively. In 4 cases experiencing LTD, myotomy and Dor fundoplication, the gastrooesophagealreflux occurred during the sleep stage. Conclusions: LTD constitutes a safe and valid approach for ED patients with severesymptoms. As not all patients with large ED have oesophageal disorders, according to manometric and endoscopic results, surgeons cancategorise and decide whether or not myotomy and antireflux surgery after LTD will be conducted.