Oesophageal diverticula

The classification and etiopathogenesis of oesophageal diverticula is discussed, based on the experience with the treatment of 91 (68 Zenker's, 7 parabronchial, and 16 epiphrenic) diverticulectomies performed at the First and Second Departments of Surgery in Olomouc from 1948 to 1987. The tactics and technique of surgical management and its results in the single groups of diseases are analyzed in detail. Parapharyngeal diverticula represent typical true diverticula associated with hypertonia of the upper oesophageal sphincter. No causal relationship could be proved to exist between the origin of this diverticulum and the gastrooesophageal reflux. Thoracic diverticula are probably rather of congenital than traction origin. Epiphrenic diverticula arise most often from hypertonia of the lower oesophageal sphincter. They can also be of congenital origin. Traction etiology could be observed in the presence of a leiomyoma in the diverticulum. The surgical management of Zenker's diverticulum consists in the excision of the diverticulum and cricopharyngeal myotomy. Excision of parabronchial diverticulum is seldom indicated for causing little discomfort, as a rule only when it is very large. Epiphrenic diverticula are usually associated with hypertonia of the lower oesophageal sphincter. In such cases, myotomy after Heller is performed and, as a rule, the diverticulum is excised.