Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis
J. M. Streitz Jr, M. E. Glick and F. H. Ellis Jr
Department of Thoracic and Cardiovascular Surgery, Lahey Clinic Medical Center, Burlington, MA 01805.
The pathogenesis and treatment of epiphrenic diverticula remain
controversial subjects. Most surgeons recommend esophagomyotomy in
association with diverticulectomy in every patient. We believe that
selective use of myotomy, based on manometry, should be used. From 1960 to
1990, 16 patients underwent surgical treatment for epiphrenic diverticulum
at the Lahey Clinic Medical Center, Burlington, Mass. Six patients, three
of whom underwent diverticulectomy alone and three who underwent an
associated long myotomy, had the lower esophageal sphincter left intact;
long-term results were good in all patients. The remaining 10 patients
underwent myotomy of the lower esophageal sphincter. Reflux esophagitis
developed in two of these patients who had a normal lower esophageal
sphincter. Clinical results support the selective use of esophagomyotomy
applied to areas of demonstrated dysmotility. A normal lower esophageal
sphincter should be left intact to prevent reflux complications.
