Laparoscopic enucleation of horseshoe-shaped esophageal leiomyoma: use of mini-instruments
Epublication WebSurg.com, Nov 2013;13(11). URL: http://websurg.com/doi/vd01en4053
Introduction: Leiomyoma is the most common benign tumor of the esophagus, usually arising in the inner circular muscle layer of the distal esophagus. Middle-aged men are most frequently affected. Most patients remain asymptomatic and when they become symptomatic, the main signs are usually dysphagia and epigastric pain, but they are not specific to the disease. Malignization is rare but should not be ignored. The minimally invasive approach to these tumors allows for complete extirpation with minimal morbidity and provides excellent results. Materials and methods: We present the case of a 31-year-old woman with no medical history, who underwent a CT-scan for other reasons, namely for urinary symptoms. A 3cm homogeneous, low attenuated mass was found at the gastroesophageal junction. Endoscopic ultrasound is performed and showed a 50mm horseshoe-shaped tumor affecting three quarters of the esophageal circumference. Because of clinical deterioration, and mainly of dysphagia, elective surgery was decided upon. Results: In this video, it is possible to appreciate the laparoscopic enucleation of this horseshoe-shaped tumor, which depends on the distal esophageal wall, mainly using blunt dissection. The intervention is completed with a Toupet fundoplication. The postoperative course was uneventful, and the patient is discharged on the third postoperative day, and symptoms are resolved. Conclusions: Minimally invasive laparoscopic resection of distal esophageal benign tumors is technically safe and provides the well-known advantages of laparoscopic access, achieving quick patient recovery and a short hospital stay. Some authors recommend to perform an anti-reflux procedure in order to protect the surgical resection area and therefore prevent complications due to the weakening of the lower esophageal sphincter, such as reflux symptoms.