Alberto Aiolfi1, Giancarlo Micheletto2, Domenico Tringali2, Eugenio Jonghi-Lavarini2, Gianluca Bonitta3, Giampiero Campanelli4, Davide Bona3. 1. Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy. alberto.aiolfi86@gmail.com. 2. Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy. 3. Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy. 4. Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy.
Abstract
BACKGROUND: Large middle-third esophageal diverticula are rare. Thoracotomy has been proposed as mainstay of treatment; however, minimally invasive resection through lateral or prone position thoracoscopy has been described. METHODS: The technical aspects of the novel semi-prone minimally invasive thoracoscopy (spVATS) in the management of large (> 5 cm) infracarinal traction diverticula are described. Operative outcomes, pre- and postoperative symptoms (Eckardt score) and quality of life (Short-Form 36) are analyzed. RESULTS: Four symptomatic patients underwent spVATS for traction midesophageal diverticula. The median age was 59 years and 75% were males. The median diverticulum size was 7.0 cm (range 5.5-8). The median preoperative Eckardt score was 8.4 (range 5-10), and the overall incidence of respiratory symptoms was 50%. Esophageal manometry was performed in three patients with no evidence of underlying motility disorders. The median operative time was 149 min (range 125-175). No intraoperative complications or open conversions occurred. Postoperative morbidity and mortality were 25% and 0%, respectively. The median hospital length of stay was 7.5 days (range 6-10). The median postoperative follow-up was 22 months (range 5-35). At the last follow-up, there was a significant improvement of patients' symptoms (p = 0.024) and quality of life (p < 0.05) with complete resolution of respiratory symptoms. CONCLUSION: In summary, spVATS seems a valuable approach to treat large midesophageal traction diverticula in centers experienced with minimally invasive esophageal surgery. Further studies are needed to validate the advantages and promising outcomes of the spVATS providing more robust evidence on the treatment of this rare clinical entity.
BACKGROUND: Large middle-third esophageal diverticula are rare. Thoracotomy has been proposed as mainstay of treatment; however, minimally invasive resection through lateral or prone position thoracoscopy has been described. METHODS: The technical aspects of the novel semi-prone minimally invasive thoracoscopy (spVATS) in the management of large (> 5 cm) infracarinal traction diverticula are described. Operative outcomes, pre- and postoperative symptoms (Eckardt score) and quality of life (Short-Form 36) are analyzed. RESULTS: Four symptomatic patients underwent spVATS for traction midesophageal diverticula. The median age was 59 years and 75% were males. The median diverticulum size was 7.0 cm (range 5.5-8). The median preoperative Eckardt score was 8.4 (range 5-10), and the overall incidence of respiratory symptoms was 50%. Esophageal manometry was performed in three patients with no evidence of underlying motility disorders. The median operative time was 149 min (range 125-175). No intraoperative complications or open conversions occurred. Postoperative morbidity and mortality were 25% and 0%, respectively. The median hospital length of stay was 7.5 days (range 6-10). The median postoperative follow-up was 22 months (range 5-35). At the last follow-up, there was a significant improvement of patients' symptoms (p = 0.024) and quality of life (p < 0.05) with complete resolution of respiratory symptoms. CONCLUSION: In summary, spVATS seems a valuable approach to treat large midesophageal traction diverticula in centers experienced with minimally invasive esophageal surgery. Further studies are needed to validate the advantages and promising outcomes of the spVATS providing more robust evidence on the treatment of this rare clinical entity.
Authors: Hiran C Fernando; James D Luketich; John Samphire; Miguel Alvelo-Rivera; Neil A Christie; Percival O Buenaventura; Rodney J Landreneau Journal: Ann Thorac Surg Date: 2005-12 Impact factor: 4.330
Authors: David S Y Chan; Antonio Foliaki; Wyn G Lewis; Geoffrey W B Clark; Guy R J C Blackshaw Journal: J Gastrointest Surg Date: 2017-01-20 Impact factor: 3.452