European Journal of Cardio-Thoracic Surgery, Vol 6, 330-334, Copyright © 1992 by European Association for Cardio-thoracic Surgery
Esophageal diverticula. Physiopathological basis for surgical management
D D'Ugo, G Cardillo, P Granone, R Coppola, S Margaritora and A Picciocchi
Department of Surgery, Catholic University of Rome, Italy.
From 1980 to 1990, 31 patients were treated surgically in our department
for esophageal diverticula: 12 Zenker's diverticula (ZD); 11 mid-thoracic
diverticula (MTD); 8 epiphrenic diverticula (ED). Cricopharyngeal
dysfunction was detectable in 8 of 12 ZD patients (66.6%). Cricopharyngeal
myotomy with diverticulectomy was performed in all cases. There were no
deaths. Relief of dysphagia was obtained in all cases. No recurrences of
dysphagia or diverticulum were observed at a mean follow-up of 3 years. A
motility disorder was observed in 10 of 11 MTD (90.9%). An extended
esophageal myotomy with diverticulectomy was performed in 3 cases, an
extended myotomy alone in 3 cases, a diverticulectomy alone in 5 cases; an
anti-reflux procedure was added in 6 cases. One patient died on the 7th
postoperative day. All remaining patients were free of symptoms at a mean
follow-up of 3.2 years. A motor dysfunction was detected in all 8 ED
patients (100%). No diverticulectomy was performed. Six patients underwent
Heller-Dor myotomy and 2 underwent Nissen fundoplication. There were no
deaths. Relief of symptoms was obtained in all patients, at a mean
follow-up of 3.1 years. Myotomy with diverticulectomy represents the
treatment of choice in ZD. As regards MTD and ED, the treatment of the
underlying motor disorder is the main therapeutic goal, whereas
diverticulectomy is reserved to selected patients.
