Large epiphrenic oesophageal diverticulum with hiatus hernia: Excellent outcome with laparoscopic transhiatal approach

Epiphrenic oesophageal diverticulum (ED) is a rare condition often associated with oesophageal motility disorders, most notably achalasia cardia. Symptoms include dysphagia, regurgitation, chest pain, halitosis and respiratory symptoms. Surgical management includes diverticulectomy, Heller's cardiomyotomy and partial fundoplication. While thoracic approaches were traditionally used, the laparoscopic transhiatal approach offers distinct advantages. We report the case of a 69-year-old female presenting with dysphagia, foul-smelling regurgitation and chest pain. Her Eckardt score was seven. Investigations revealed a large left-sided epiphrenic diverticulum, type 2 achalasia and a sliding hiatal hernia. She underwent laparoscopic transhiatal diverticulectomy using an endoscopic stapler, Heller's cardiomyotomy, crural repair and anterior Dor fundoplication. Intraoperative endoscopy was used to guide stapling, assess adequacy of the myotomy and check mucosal integrity. The surgery and post-operative course were uneventful. The patient was started on oral liquids on post-operative day 1 and was discharged on day 5. Follow-up at 1 and 3 months revealed complete resolution of symptoms with Eckardt scores of 2 and 0, respectively. No post-operative complications were observed during the 5-month follow-up. Diverticulectomy using an endostapler, Heller's cardiomyotomy and Dor's fundoplication, performed through a laparoscopic transhiatal approach with intraoperative upper gastrointestinal endoscopy monitoring, is a safe and effective method of treating symptomatic ED.