[Surgical indication and technique in diverticulosis of the esophagus]

Diverticula of the oesophagus are a rare disease with an interesting patho-physiology which is the basis for a correct indication and surgical procedure. Our experience bases on 72 operated cases with a long follow-up. The pharyngo-oesophageal or Zenker's diverticulum and the epiphrenic diverticulum are pulsion diverticula above an achalasic sphincter: the upper cervical and the LES. A surgical treatment is necessary in the most cases of Zenker's, in the epiphrenic form depending on symptoms and risk. The treatment of Zenker's is a cervicotomy with diverticulectomy (we use a stapler) and accurate myotomy of the cricopharyngeus. A beginning little D or a cervical achalasia without D are often the cause of serious and lasting symptoms. Here the alone cricomyotomy is the procedure of choice. Reflux disease is frequently associated with Zenker's, sometimes a surgical problem too. The operation of the epiphrenic D is a left thoracotomy with diverticulectomy and the very important abolition of the causal achalasia with myotomy and antireflux (by us a fundoplication). The traction diverticula of the thoracic oesophagus are frequently asymptomatic. Operation with right thoracotomy is exceptionally necessary on painful segmental dyskinesia of bezoar. It is essential on oesophago-respiratory fistula.