Surgical management of esophageal thoracic diverticula

Abstract

Between 1969 and 1989, thirty-three patients were admitted for the treatment of a mid- or lower thoracic diverticulum and were investigated. Their mean age was 63 years. The predominant symptoms were dysphagia and regurgitations of, on average, 5.8 years' duration. Three patients had associated carcinoma and were excluded from the study. Three patients with mild complaints were managed medically and 27 surgically. Surgical treatment included, prior to 1979, simple diverticulectomy in 10 patients since 1970 diverticulectomy and myotomy through a right thoracic approach in one patient diverticulectomy, esophageal myotomy and fundoplication through a left thoracic approach in 10 patients and simple abdominal esophageal myotomy with fundoplication in 4 patients. In 2 patients, an esophagobronchial fistula was successfully treated. There were 3 postoperative deaths (2 suture line leakages and one massive aspiration pneumonia). Two patients had persistent dysphagia: one was reoperated on for a subsequent abdominal esophageal myotomy and the other one for severe reflux esophagitis following esophageal dilatations. Four patients had reflux esophagitis and two were reoperated on for a total duodenal diversion. The importance of the long esophageal myotomy extended on to the cardia through a left thoracotomy, and of a good antireflux procedure after the myotomy, in the treatment of thoracic esophageal diverticula is emphasized.