Large oesophageal epiphrenic diverticulum resected by transhiatal robotic-assisted approach -- case report. 2015

L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu

BACKGROUND Epiphrenic diverticula (ED) represent about 20% of oesophageal diverticula. They are considered to be pulsion diverticula, characterized by out pouchings of the oesophageal mucosa originating in the distal 10 cm of the oesophagus and are frequently associated with spastic oesophageal dysmotility. The most frequent clinical manifestations of ED are dysphagia, regurgitations and chest pain. Only symptomatic diverticula should be treated by surgery. The surgical procedure can be performed minimally invasively by robotic approach and consists of diverticulectomy,hiatus calibration and an antireflux procedure, usually adding an esophagomiotomy as well. METHODS We present the case of 43-year-old male patient who was admitted for a four-month history of epigastric pain, pyrosis and regurgitations. Preoperative investigation shave shown an epiphrenic diverticulum 6 cm large in diameter.A robotic-assisted transhiatal diverticulectomy with a linear endostapler, hiatal calibration and a Nissen-Rossetti fundoplication were performed using a three-arm da Vinci Robotic System. Operative time was 150 min. Postoperative course was uneventful and the patient was discharged on postoperative day 9, without complications. Ten days later,he came back and was readmitted under emergency status for right chest pain, dyspnoea and fetid breath, being diagnosed with a right empyema secondary to a delayed fistula of the oesophageal suture line. A right minimal pleurotomy and pleural drainage under local anaesthesia were performed and an intravenous antibiotherapy was started with complete remission of symptomatology, the patient remaining asymptomatic after 18 months of follow-up. CONCLUSIONS Robotic approach is a feasible and safe minimally invasive surgical option in the treatment of selected cases of ED. We consider transhiatal abdominal robotic approach possible in almost all cases of ED, regardless of size,thus avoiding thoracic approach and its possible major complications.The most common serious complication after surgery of ED is post diverticulectomy suture line fistula, but if properly and rapidly diagnosed it could be conservatively treated with very good results.

UI MeSH Term Description Entries
D008297 Male Males
D010535 Laparoscopy A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy. Celioscopy,Laparoscopic Surgical Procedures,Peritoneoscopy,Surgical Procedures, Laparoscopic,Laparoscopic Assisted Surgery,Laparoscopic Surgery,Laparoscopic Surgical Procedure,Procedure, Laparoscopic Surgical,Procedures, Laparoscopic Surgical,Surgery, Laparoscopic,Surgical Procedure, Laparoscopic,Celioscopies,Laparoscopic Assisted Surgeries,Laparoscopic Surgeries,Laparoscopies,Peritoneoscopies,Surgeries, Laparoscopic,Surgeries, Laparoscopic Assisted,Surgery, Laparoscopic Assisted
D002637 Chest Pain Pressure, burning, or numbness in the chest. Precordial Catch,Precordial Catch Syndrome,Texidor's Twinge,Chest Pains,Pain, Chest,Pains, Chest,Syndrome, Precordial Catch,Texidor Twinge
D003680 Deglutition Disorders Difficulty in SWALLOWING which may result from neuromuscular disorder or mechanical obstruction. Dysphagia is classified into two distinct types: oropharyngeal dysphagia due to malfunction of the PHARYNX and UPPER ESOPHAGEAL SPHINCTER; and esophageal dysphagia due to malfunction of the ESOPHAGUS. Dysphagia,Swallowing Disorders,Esophageal Dysphagia,Oropharyngeal Dysphagia,Deglutition Disorder,Disorders, Deglutition,Dysphagia, Esophageal,Dysphagia, Oropharyngeal,Swallowing Disorder
D004936 Diverticulum, Esophageal Saccular protrusion beyond the wall of the ESOPHAGUS. Esophageal Diverticulum,Diverticula, Esophageal,Esophageal Diverticula
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D049630 Esophageal Sphincter, Lower The physiologic or functional barrier to GASTROESOPHAGEAL REFLUX at the esophagogastric junction. Sphincteric muscles remain tonically contracted during the resting state and form the high-pressure zone separating the lumen of the ESOPHAGUS from that of the STOMACH. (Haubrich et al, Bockus Gastroenterology, 5th ed., pp399, 415) Lower Esophageal Sphincter,Gastroesophageal Sphincter,Gastroesophageal Sphincters,Sphincter, Gastroesophageal,Sphincter, Lower Esophageal
D057045 Laryngopharyngeal Reflux Back flow of gastric contents to the LARYNGOPHARYNX where it comes in contact with tissues of the upper aerodigestive tract. Laryngopharyngeal reflux is an extraesophageal manifestation of GASTROESOPHAGEAL REFLUX. Regurgitation, Gastric,Supraesophageal Gastric Reflux,Supraesophageal Gastric Reflux (SEGR),Gastric Reflux, Supraesophageal,Gastric Reflux, Supraesophageal (SEGR),Gastric Regurgitation,Reflux, Laryngopharyngeal,Reflux, Supraesophageal Gastric,Reflux, Supraesophageal Gastric (SEGR)

Related Publications

L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu
October 2009, Surgical laparoscopy, endoscopy & percutaneous techniques,
L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu
June 2019, The Medical journal of Malaysia,
L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu
January 2022, Journal of minimal access surgery,
L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu
January 2002, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen,
L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu
January 2008, JSLS : Journal of the Society of Laparoendoscopic Surgeons,
L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu
January 2005, Chirurgia italiana,
L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu
January 1988, Scandinavian journal of thoracic and cardiovascular surgery,
L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu
January 2002, Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus,
L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu
December 2016, Journal of robotic surgery,
L Alecu, and M Bărbulescu, and B Ursuţ, and V Braga, and I Slavu
March 2012, Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy,
Copied contents to your clipboard!