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Article
May 1992

Selective Use of Myotomy for Treatment of Epiphrenic DiverticulaManometric and Clinical Analysis

Author Affiliations

From the Departments of Thoracic and Cardiovascular Surgery (Dr Streitz) and Gastroenterology (Dr Click), Lahey Clinic Medical Center, Burlington, Mass; the Division of Cardiothoracic Surgery, New England Deaconess Hospital, Boston, Mass (Dr Ellis); and Harvard Medical School, Boston (Drs Streitz, Glick, and Ellis).

Arch Surg. 1992;127(5):585-588. doi:10.1001/archsurg.1992.01420050109014
Abstract

• 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.

(Arch Surg. 1992;127:585-588)

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