MIS approach for diverticula of the esophagus


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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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Published 01 January 2010
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Er J Med Res (2010) 15: 390-396
Sepember 24, 2010
 I. Hzape Pbishers 2010
MIS APPRoAcH foRDIvERtIculA of tHEESoPHAguS t. laber1, P. Hidebrad1, u. J. Rbik1, M. Kras1, H. Esaashari1, P. Weher2, H. P. Brh1 1Deparme  Srer, uiersi  Sheswi-Hsei, camps lbek, lbek, germa, 2 Mediie I, uiersi  Sheswi-Hsei, camps lbek, lbek, germaDeparme
Abstract Pur pose: esphas represe a rare heDieria  pahia ei. Disi assiiais  he dis-ease imp diere sria eps. Srer shd be resered r smpmai paies . Miima iasie srer (MIS) r reame  esphaea di-eria empasses riid ad eibe iramia edsp, hrasp ad aparsp. We here ie a eriew  he paheesis  esphaea dieria, he miima iasie sria ehies r reame ad he ree ierare. Addiia, we prese r w eperiee wih MIS r midh-rai dieria. Methods:We aazed he ases  wh - paies derwe MIS r midhrai dieria wih reard  preperaie smpms, periperaie ad w-p daa. Results:three paies (w emae, e mae, ae 79, 78 ad 59 ears) reeied hraspi srer r midhrai dieria. A paies repred  ds-phaia ad reriai. I w paies pH-iesia-i shwed pahia re b mamer was rma i a paies. operai ime was 205, 135 ad 141 mies. We perrmed iraperaie ira-mia edsp i a paies. there were  ira-peraie mpiais ad ahh  sria m-piais red psperaie e paie dee-ped pemia whih adaed  sepsis ad eha mi ra aire. up w-p he w paies did  hae rerre dieria r a rerree  preis smpms. Conclusions: Srer r dieriar disease  he esphas has bee assiaed wih hih raes  mr-bidi ad mrai. Despie he eha -sria mpiai we eered, wih reard  ree pbiais miima iasie apprahes  rea pa-ies wih smpmai esphaea dieria eai wer raes  mpiais wih beer  erm re-ss i mparis  pe srer.
Key words:esphas, dieria, miima iasie srer, dieriem, w-p IntRoDuctIon Dieria  he esphas represe a bei esphaea disrder. the repred preaee raes bewee 0.015% ad 2% b  sedm he beme smpmai ad hs appare [1, 2]. Esphaea di-eria are sa sie b are as repred  -
r shrs i p  25% [3]. Diere a-is wih disi pahphsiia mehaisms i heir rree imp diere ehies  hera-pei sraeies. geera, srer shd be resered r smpmai paies . tehia adaes ad researh i aparspi ad hraspi srer epaded he appiabii  miima ia-sie perais  ma eera ad isera srer predres. B w, hraspi, aparspi ad edspi apprahes r dieriem hae bee esabished [4-6]. I ma siais, redez-s pr-edres, i.e. he mbiai  edsp ad hra--/aparsp appear arabe ad res i d ia mes. Hweer, de  he rare r-ree  esphaea dieria prspeie radm-ized rias  ssemaia aaze diere sria eps hae  bee se p ad ms daa aaiabe is based  rerspeie eaai  peri- ad ps-peraie daa [7, 8]. We here prese he periperaie daa ad w-p ress  hree paies reaed a r ere b miima iasie srer r midh-rai dieria ad ie a eriew  he rre ierare reardi his pi. We brie desribe ehia aspes  miima iasie resei  Zekers dieria ad reiew ree daa  his par-iar pi.
the aam, ei ad smpms  esphaea dieria hae prmped w separae assiiais whih ree ai  he dieria  he e ad paheei mehaisms eadi  dieria rma-i  he her had. Predmia ais are di-re abe he pper esphaea sphier as irs aamia rre desribed b Zeker [9], parabrhia (midhrai) ad abe he wer esphaea sphier (epiphrei). Bh Zekers ad epiphrei dieria are ase dieria wih he m-sa aer prrdi hrh aps i he er ms-ar aer ad are hs sidered psi dieria. the deri mehaism i bh ases is a abr-ma mii  he esphas wih a impaired rea -ai  he sphier whie prpsie rais ie. Eide, his eads  a ireased ira-mia pressre js abe he sphiers whih he ases he msa aer  deep a ph pshi hrh weakeed sies  he msar wa [3, 10-12]. csee, he sria reame r hese dieri-