Laparoscopic transhiatal surgery for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus: a case report

Abstract

Background: An esophageal diverticulum is rare and is frequently associated with esophageal motility disorders. Jackhammer esophagus is also rare, is characterized by esophageal hypercontraction, and comprises 4.1% of esophageal motility disorders. Here, we report a case of a patient successfully treated by laparoscopic transhiatal surgery for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus diagnosed with highresolution manometry (HRM). Case presentation: The patient was a 78-year-old man who presented to the hospital with dysphagia. A diverticulum was detected in the lower part of his esophagus by upper gastrointestinal endoscopy. HRM was performed to investigate esophageal motility disorders. His integrated relaxation pressure was normal at 25.9 (< 26) mmHg, but his distal contractile integral (DCI) was very high at 21,464 (1500-13,000) mmHg s cm. Esophageal peristalsis was preserved. Therefore, the patient was diagnosed as having an epiphrenic esophageal diverticulum derived from a jackhammer esophagus for which laparoscopic transhiatal diverticulectomy and Heller-Dor procedure were performed. The postoperative course was uneventful. His symptoms improved, and the level of DCI also returned to a normal level of 3867 mmHg s cm at 2 months after the operation. Conclusion: Laparoscopic transhiatal diverticulectomy and esophagomyotomy can be useful procedures for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus due to their lower invasiveness.

Laparoscopic trans‐hiatal approach in a rare case of double giant epiphrenic diverticula: A case report

“…Even though the transthoracic approach is a safe approach, decreased respiratory function might be an adverse event, especially in patients with compromised lung function. Currently, several reports have illustrated the feasibility of the laparoscopic trans‐hiatal approach and the benefits over the transthoracic approach, particularly in an initial antireflux procedure after myotomy 5,6 . Fujinaga et al suggested that a trans‐hiatal approach is possible to address an ED located within 10 cm from the esophagogastric junction 5 .…”

“…Currently, several reports have illustrated the feasibility of the laparoscopic trans‐hiatal approach and the benefits over the transthoracic approach, particularly in an initial antireflux procedure after myotomy 5,6 . Fujinaga et al suggested that a trans‐hiatal approach is possible to address an ED located within 10 cm from the esophagogastric junction 5 . However, a tailored combined laparoscopic and thoracoscopic approach was suggested to address an ED located at the mid‐thoracic level of the esophagus or an ED with a large neck 8 .…”

“…5,6 Fujinaga et al suggested that a transhiatal approach is possible to address an ED located within 10 cm from the esophagogastric junction. 5 However, a tailored combined laparoscopic and thoracoscopic approach was suggested to address an ED located at the mid-thoracic level of the esophagus or an ED with a large neck. 8 In this case, severe intrathoracic adhesion was predicted as a result of prior tuberculosis.…”

“…In a larger ED, most surgeons prefer the transthoracic approach to avoid surgical difficulties. However, several reports have suggested the feasibility of the trans‐hiatal approach, which is superior in reducing respiratory complications 5,6 …”

“…However, several reports have suggested the feasibility of the trans-hiatal approach, which is superior in reducing respiratory complications. 5,6 We describe a successful laparoscopic trans-hiatal approach combined with an intraoperative endoscopic examination in double giant esophageal diverticula, in which the proximal part was at the mid-thoracic esophagus.…”