Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum

Abstract

Background: We evaluated outcome after laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication.

Methods: Patients with symptomatic achalasia and epiphrenic diverticula underwent laparoscopic diverticulectomy, Heller myotomy, and partial fundoplication. Intraoperative endoscopy and postoperative esophagography were performed in all patients. Patients graded preoperative and postoperative dysphagia and heartburn on a Likert scale.

Results: Anterior fundoplication was performed in five patients and posterior fundoplication in one. Mean follow-up was 9 months (range, 1-17 months). One intraoperative complication occurred--an esophagotomy that was laparoscopically repaired. There were no postoperative leaks. Patient-reported dysphagia decreased from 4.5 +/- 0.8 (mean +/- SD) to 1.8 +/- 1.7 ( p < 0.05 matched pair analysis). Heartburn decreased from 4.3 +/- 0.8 to 1.3 +/- 1.3 ( p < 0.05). All patients reported improvement in symptoms after operation.

Conclusion: Laparoscopic esophageal diverticulectomy, Heller myotomy, and partial fundoplication with intraoperative endoscopy safely reduce dysphagia associated with achalasia and esophageal diverticula while limiting symptoms of gastroesophageal reflux.