ABSTRACT
Pulsion diverticula of the distal esophagus are considered to be complications of abnormal intraesophageal pressures. The work of Cross and colleagues supported the concept that spasm of the inferior sphincter accompanied by increased contraction pressures in the esophageal body is responsible for both the symptoms and the appearance of the diverticulum. Allen and Claggett and Benacci et al. have reported significantly fewer leaks with secondary sepsis when a myotomy is combined with diverticulectomy than when a diverticulectomy alone is performed. When surgical treatment is indicated for a distal esophageal diverticulum, the diverticulum should be excised if it is large enough and the underlying motor abnormality corrected. After myotomy, a significant weakening of the gastroesophageal junction results, and an antireflux repair is added to the myotomy to prevent reflux damage to the esophageal mucosa. A partial fundoplication is preferred, as a more complete wrap causes functional obstruction to an esophagus made powerless by the myotomy.
