Saccular oesophageal diverticulum at the site of enucleation of a leiomyoma

[Esophageal leiomyoma. Six cases of video-assisted enucleation]

AIM OF THE STUDY

To report our experience with video-assisted enucleation of esophageal leiomyomas.

METHOD

Retrospective analysis of six (five men and a woman) patients who underwent video-assisted submucosal tumor enucleation (4 with thoracoscopy and 2 with laparoscopy).

RESULTS

Only one patient had postoperative complications: a parietal hematoma at a trocar site and a fever with right pleural, resolved after pleural drainage. Outcome was satisfactory for all patients, and no relapses have been noted.

CONCLUSION

Video-assisted surgery offers incontrovertible advantages for the treatment of this benign pathology.

Thoracoscopic enucleation of a large esophageal leiomyoma using a three thoracic ports technique

Background

Video assisted thoracoscopic resection of an esophageal leiomyoma offers distinct advantages over an open approach. Many papers have described various techniques of thoracoscopic resection.

Case presentation

We describe a 32-year old man who presented with intermittent dysphagia. Imaging studies showed a large esophageal leiomyoma. He underwent thoracoscopic enucleation using a three thoracic-ports technique.

Conclusion

Thoracoscopic enucleation can be technically performed using a three thoracic-ports technique.

Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach

BACKGROUND

Surgical enucleation of submucosal tumors (SMTs) of the esophagus (mostly leiomyomas) is indicated when either the tumors are symptomatic or their biological behavior is unclear. The classic approach is a thoracotomy, but tumor enucleation can now also be performed via thoracoscopy or, for distal tumors, via laparoscopy.

METHODS

We assessed our experience with the different approaches in a total of 25 patients (n = 13 minimally invasive approach and n = 12 open surgery). Enucleation of the SMT was the basic surgical principle; the choice of the approach was based on the preference of the surgeon.

RESULTS

Compared to open surgery, the minimally invasive approach reduced pulmonary complications, hospital stay, and postoperative wound-related pain. The operating time was the same for both approaches.

CONCLUSION

Minimally invasive approaches are suitable for the surgical enucleation of submucosal esophageal tumors. Thoracoscopic and laparoscopic techniques are recommended as standard procedures in experienced centers.

Thoracoscopic enucleation of a leiomyoma of the upper thoracic esophagus

The authors present two cases of leiomyoma of the upper esophagus. Both of the cases presented with dysphagia, and one patient complained of pyrosis. An upper gastrointestinal endoscopy showed midesophageal narrowing without mucosal irregularity, suggestive of leiomyoma. The patients were successfully treated by thoracoscopic enucleation of the leiomyoma, using four thoracic trocars. In one patient (Case 1), the azygus vein had to be divided. Both of the patients are asymptomatic in the late-postoperative period.

Oesophageal diverticula

BACKGROUND

Oesophageal pulsion diverticula, excluding pharyngeal types, are uncommon sequelae of oesophageal dysmotility. Current opinion favours myotomy as effective therapy, but the role of diverticulectomy, myotomy selection and placement, and the need for fundoplication remain unresolved.

METHODS

A Medline search and review of references identified relevant English language articles. Data on epidemiology, aetiology, oesophageal motility, pathology, symptomatology, investigations, surgical management and outcome were examined.

RESULTS

Data were largely retrospective. Significant morbidity and mortality were associated with pulmonary aspiration and diverticulectomy site leaks. Surgical outcome was similar whether or not a diverticulectomy was added to a myotomy, but a myotomy clearly reduced the risk of leaks. Fundoplication reduced the incidence of postcardiomyotomy reflux symptoms. Results from minimally invasive techniques were similar to those of open surgery.

CONCLUSION

Surgery should be reserved for symptomatic patients; asymptomatic patients may benefit from surveillance. Pulmonary aspiration mandates surgical intervention. Myotomy remains the mainstay of treatment and an adequate subdiverticular extension is crucial in relieving obstruction. A partial fundoplication is preferred in selected patients. Minimally invasive techniques should become the routine approach for oesophageal pulsion diverticula.

Thoracoscopic enucleation of an esophageal leiomyoma

A series of reports in the literature suggest that video assisted thoracoscopic resection of an esophageal leiomyoma offers distinct advantage over open approach. We describe a patient with esophageal leiomyoma who underwent surgical resection via thoracoscopic approach using four thoracic trocars. The postoperative period was uneventful and the patient was discharged on postoperative day 3.

VATS resection of an oesophageal leiomyoma in a patient with neurofibromatosis Recklinghausen

A series of reports in the literature suggest an association of neurofibromatosis Recklinghausen with intestinal tumors as carcinoids, leiomyomas and leiomyosarcomas. We present a case of a 23-year-old man with severe cutaneous manifestation of neurofibromatosis. Dysphagia was the main symptom. CT scan suggested the diagnosis of an oesophageal leiomyoma. The oesophageal muscle layers were split and the tumor was enucleated by video assisted thoracoscopic surgery (VATS). The postoperative course was uneventful. The patient was drinking liquids from day 1 and was eating a normal diet from day 3 postoperatively. He was dismissed from the hospital on the 4th postoperative day. We conclude that in patients with neurofibromatosis and oesophageal symptoms an intestinal manifestation of the disease in the oesophagus has to be considered and that VATS resection of intramural and extrinsic oesophageal leiomyomas is the treatment of choice.