Digestive, esogastric and bariatric surgery department, Bichat Claude Bernard hospital, Paris, France; Sorbonne university, 75013 Paris, France.
Digestive, esogastric and bariatric surgery department, Bichat Claude Bernard hospital, Paris, France; Department of digestive and oncologic surgery, européen Georges Pompidou hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm UMR 1149, Paris university, 75018 Paris, France.
J Visc Surg. 2023 Aug;160(4):245-252. doi: 10.1016/j.jviscsurg.2023.01.003. Epub 2023 Jan 27.
Management of diverticulum of the lower esophagus or epiphrenic diverticulum can be performed using the abdominal or thoracic approach. In some cases, the thoracic approach is preferred, but few studies have described thoracoscopic resection. The objective of the present study was to investigate the thoracoscopic approach for management of epiphrenic esophageal diverticulum.
From 2008 to 2018, all patients undergoing surgery for epiphrenic esophageal diverticulum by the thoracoscopic approach were included in this single-center, retrospective, observational study. Data on diverticulum, surgery and follow-up were assessed.
During the study period, 14 patients underwent surgery. Two patients had two diverticula. The mean location of the superior edge of the diverticulum was 7cm (2-14cm) above the gastro-esophageal junction. The mean size of the diverticulum was 39 millimeters (20-60). Thoracoscopic approach was used in all patients. No conversion to thoracotomy was required. Mean operative time was 168min (120-240). No postoperative mortality occurred. The overall complication rate was 40% (6 complications out of 15 resections), with three major complications including leaks (n=2) and a case of bronchoesophageal fistula (n=1). Median length of hospital stay was 12 days (8-40). At a mean postoperative follow-up of 20.7 months (5-71), 85% of patients had complete disappearance of preoperative symptoms without recurrence of the diverticulum on the barium swallow study test.
Thoracoscopic approach as management of epiphrenic diverticulum is feasible, with acceptable short-term morbidity. The thoracoscopic approach is also effective in resolving preoperative symptoms.
下食管憩室或膈上憩室的治疗可通过腹部或胸部途径进行。在某些情况下，首选胸部途径，但很少有研究描述过胸腔镜切除。本研究的目的是探讨胸腔镜治疗膈上食管憩室的方法。
从 2008 年到 2018 年，所有接受胸腔镜治疗膈上食管憩室的患者均纳入本单中心、回顾性、观察性研究。评估憩室、手术和随访数据。
研究期间，14 名患者接受了手术。两名患者有两个憩室。憩室上缘的平均位置在胃食管交界处上方 7cm（2-14cm）。憩室的平均大小为 39 毫米（20-60）。所有患者均采用胸腔镜入路。无需转为开胸手术。平均手术时间为 168 分钟（120-240 分钟）。无术后死亡。总的并发症发生率为 40%（15 例切除中有 6 例并发症），包括 2 例漏诊和 1 例支气管食管瘘。中位住院时间为 12 天（8-40 天）。在平均术后随访 20.7 个月（5-71 个月）时，85%的患者术前症状完全消失，钡餐检查未见憩室复发。
胸腔镜治疗膈上憩室是可行的，短期发病率可接受。胸腔镜方法也能有效解决术前症状。
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