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Long oesophageal myotomy and excision of diverticula

  • André Duranceau
Chapter

Abstract

Pulsion diverticula of the distal oesophagus are considered to be complications of abnormal intraoesophageal pressures. Cross et al.1,2 supported the concept that spasm of the inferior sphincter accompanied by increased contraction pressures in the oesophageal body is responsible for both the symptoms and the appearance of the diverticulum. Allen and Claggett3 and Benacci et al.4 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 distal oesophageal diverticula, the diverticulum should be excised if it is large enough and the underlying motor abnormality corrected. Following myotomy, a significant weakening of the gastrooesophageal junction results, and an antireflux repair is added to the myotomy to prevent reflux damage to the oesophageal mucosa. A partial fundoplication is preferred, as a more complete wrap causes functional obstruction to an oesophagus made powerless by the myotomy.

Keywords

Partial Fundoplication Epiphrenic Diverticulum Esophageal Diverticulum Oesophageal Mucosa Oesophageal Lumen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Cross FS. Esophageal diverticula related neuromuscular problems. Ann Otol 1968; 77: 914–26.Google Scholar
  2. 2.
    Cross FS, Johnson GF, Gerein AN. Esophageal diverticula. Arcb Surg 1961; 83: 525–33.CrossRefGoogle Scholar
  3. 3.
    Allen TH, Claggett OT. Changing concepts in the surgical tratment of pulsion diverticula of the lower esophagus. J Tborac Cardiovasc Surg 1965; 50: 455–62.Google Scholar
  4. 4.
    Benacci JC, Deschamps C, Trastek V, Allen MS, Daly RC, Pairolero PC. Epiphrenic diverticulum: results of surgical treatment. Ann Thorac Surg 1993 (in press).Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1994

Authors and Affiliations

  • André Duranceau
    • 1
  1. 1.Department of Surgery, Division of Thoracic SurgeryUniversity of Montréal, Hôtel-Dieu de MontréalMontréalCanada

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