Minimally invasive surgical management of mid- to distal esophageal diverticula: a large single-center review

PURPOSE: This study aimed to investigate the outcomes of minimally invasive surgery for mid- to distal thoracic esophageal diverticula (TED). METHODS: This was a retrospective review of patients who underwent surgery for symptomatic TED. Patients with Zenker diverticulum were excluded. Demographic information and operative details were recorded. Dysphagia score was defined using the Knyrim scoring system (0 = no dysphagia, 1 = hard solids, 2 = soft solids, 3 = liquids, and 4 = saliva). The follow-up included clinical encounters, barium esophagram in all patients, and endoscopy in those who developed postoperative symptoms. RESULTS: From September 2001 to September 2024, there were 91 patients with a median follow-up of 19 months. Of note, 79 patients (86.8%) presented with dysphagia. Achalasia was identified in 27 patients. Surgical approaches included thoracoscopy (58.2%), laparoscopy (31.9%), or both (8.8%). Myotomy was performed in 85.7% of patients. There were no perioperative mortalities. The median hospital length of stay was 6 days. Of note, 6 patients had an esophageal leak postoperatively, and 4 patients required intervention. Of the 26 patients with a residual or recurrent diverticulum, only 4 required reoperation. At the first postoperative visit, all patients reported an improvement in their dysphagia scores, and 88.6% of patients reported no dysphagia. At a median follow-up of 19 months, 30 patients reported some degree of dysphagia, but overall, the dysphagia scores remained significantly improved compared with those in the preoperative period (P <.001). CONCLUSION: Minimally invasive treatment of symptomatic, mid- to lower TED resulted in significant improvement in dysphagia scores and low morbidity.