Laparoscopic Heller myotomy and Dor fundoplication combined with laparoscopic diverticular introversion suturing for achalasia complicated by epiphrenic diverticulum: report of a case

Surg Today. 2010;40(2):158-61. doi: 10.1007/s00595-009-4021-x. Epub 2010 Jan 28.

Abstract

A 41-year-old woman was admitted due to dysphagia and weight loss of 6 kg. An upper gastrointestinal radiographic contrast study demonstrated an S-shaped lower esophagus with a peak transverse diameter of 65 mm. Moreover, an epiphrenic diverticulum was also detected in the lower part of the esophagus (50 x 40 mm). The measurement of intraesophageal pressure showed a lower esophageal sphincter pressure of 80 mmHg and a lower esophageal sphincter length of 31 mm. Esophageal clearance assessment via a timed barium esophagogram demonstrated impaired contrast clearance, with a rate of 26% at 5 min. A laparoscopic Heller myotomy, Dor fundoplication, and diverticular introversion suturing were performed. The postoperative course was uneventful and the patient was discharged on day 4. At the 2-year follow-up, no dysphagia was present. This is the first report of a laparoscopic diverticuloplasty using an introversion buried suture with a Heller myotomy and Dor fundoplication for achalasia complicated by an epiphrenic diverticulum.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Diverticulum, Esophageal / complications*
  • Diverticulum, Esophageal / diagnostic imaging
  • Diverticulum, Esophageal / surgery*
  • Esophageal Achalasia / complications*
  • Esophageal Achalasia / diagnostic imaging
  • Esophageal Achalasia / surgery*
  • Female
  • Fundoplication / methods*
  • Humans
  • Laparoscopy / methods*
  • Radiography
  • Suture Techniques
  • Treatment Outcome