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Review
. 2003 Apr-Jun;7(2):165-9.

Laparoscopic Heller myotomy with epiphrenic diverticulectomy

Timothy J Pitchford  1 , Phillip D Price
Affiliations
Review

Laparoscopic Heller myotomy with epiphrenic diverticulectomy

Timothy J Pitchford et al. JSLS. 2003 Apr-Jun.

Abstract

Background and objectives: To describe the technique and results of laparoscopic Heller myotomy and Toupet fundoplication combined with epiphrenic diverticulectomy.

Case report: A 75-year-old man presented to our institution complaining of dysphagia to solid foods and liquids. The preoperative preparation included a barium swallow, esophagoscopy, and esophageal manometry. Three months earlier, the patient had a botulinum toxin injection, which provided temporary relief. Ten months later, the patient underwent a laparoscopic Heller myotomy and Toupet fundoplication combined with an epiphrenic diverticulectomy.

Results: No complications occurred. The patient tolerated clear liquids on postoperative day 1; on postoperative day 2, he was discharged tolerating full liquids. He returned to full activity in 1 week.

Conclusions: Epiphrenic diverticulectomy combined with treatment for the underlying motor disorder and gastroesophageal reflux prevention is an accepted practice. We demonstrate that this rare problem can be approached with the laparoscopic technique. Given this favorable result, we plan to continue this technique and establish a longer follow-up and wider series.

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Figures

Figure 1.
Figure 1.
Preoperative barium esophogram picturing the esophageal diverticulum and stenotic LES.
Figure 2.
Figure 2.
Esophageal diverticulum extending toward the right hemithorax.
Figure 3.
Figure 3.
Postoperative barium esophogram showing widely patent LES and no extravasation from diverticulectomy site.
See this image and copyright information in PMC

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