340 Laparoscopic Excision of Epiphrenic Esophageal Diverticulum

Abstract Introduction Epiphrenic diverticulum is a rare esophageal disorder, usually affecting the lower esophagus and often linked to underlying motility disturbances. Symptomatic cases typically require surgical management, with minimally invasive techniques increasingly preferred for improved outcomes. Case Report A 62-year-old gentleman presented with a 9-month history of dysphagia, regurgitation, and vomiting. He experienced frequent episodes of distress and choking while eating. Barium esophagography revealed a diverticulum in the distal third of the esophagus, 3–4 cm above the cardia. Manometry demonstrated severe dysmotility and complete relaxation of the lower esophageal sphincter, confirming the diagnosis of epiphrenic diverticulum. The patient underwent laparoscopic excision of the diverticulum. Surgery was performed in a modified lithotomy position with a 30° reverse Trendelenburg tilt. After establishing pneumoperitoneum, four operating ports were placed in addition to the supraumbilical telescope port. The phreno-esophageal membrane was divided, and the diaphragmatic crura were exposed. Careful blunt dissection in the mediastinum allowed identification and mobilization of the large anterior diverticulum, which was resected using a linear endostapler. Intraoperative endoscopy confirmed the integrity of the esophageal lumen and absence of leaks. A cardiomyotomy and partial fundoplication were performed to address motility issues and prevent postoperative reflux. Postoperatively, the patient’s recovery was uneventful. A water-soluble contrast study showed no leak, and oral intake was resumed. He was discharged on postoperative day seven. At six months follow-up, he remained asymptomatic, demonstrating the safety and efficacy of the laparoscopic approach for symptomatic epiphrenic diverticulum as compared to the conventional open thoracic approach.