Large Oesophageal Epiphrenic Diverticulum Resected by Transhiatal Robotically-Assisted Approach - Case Report
L. Alecu, M. Bărbulescu, B. Ursuţ, V. Braga, I. SlavuClinical case, no. 1, 2015
Introduction: Epiphrenic diverticula (ED) represent about20% of oesophageal diverticula. They are considered to bepulsion diverticula, characterized by outpouchings of theoesophageal mucosa originating in the distal 10 cm of theoesophagus and are frequently associated with spasticoesophageal dysmotility. The most frequent clinicalmanifestations of ED are dysphagia, regurgitations and chest pain. Only symptomatic diverticula should be treated bysurgery. The surgical procedure can be performed minimallyinvasively by robotic approach and consists of diverticulectomy,hiatus calibration and an antireflux procedure, usuallyadding an esophagomiotomy as well.Case-report: We present the case of 43-year-old male patientwho was admitted for a four-month history of epigastricpain, pyrosis and regurgitations. Preoperative investigationshave shown an epiphrenic diverticulum 6 cm large in diameter.A robotic-assisted transhiatal diverticulectomy with alinear endostapler, hiatal calibration and a Nissen-Rossettifundoplication were performed using a three-arm da VinciRobotic System. Operative time was 150 min. Postoperativecourse was uneventful and the patient was discharged onpostoperative day 9, without complications. Ten days later,he came back and was readmitted under emergency statusfor right chest pain, dyspnoea and fetid breath, being diagnosedwith a right empyema secondary to a delayed fistula ofthe oesophageal suture line. A right minimal pleurotomyand pleural drainage under local anaesthesia were performedand an intravenous antibiotherapy was started with completeremission of symptomatology, the patient remainingasymptomatic after 18 months of follow-up.Conclusions: Robotic approach is a feasible and safe minimallyinvasive surgical option in the treatment of selectedcases of ED. We consider transhiatal abdominal roboticapproach possible in almost all cases of ED, regardless of size,thus avoiding thoracic approach and its possible major complications.The most common serious complication aftersurgery of ED is postdiverticulectomy suture line fistula, butif properly and rapidly diagnosed it could be conservativelytreated with very good results.
