[Therapy of esophageal diverticula].
Diverticula of the esophagus can be divided into two categories. Pulsion diverticula result from an increased pressure gradient through the upper esophageal sphincter resulting in herniation of the mucosa through a weak point of the muscle layer. There are two types: hypopharynx (Zenker) diverticulum and epiphrenic diverticulum. Traction diverticula result from inflammatory reactions in neighboring lymph nodes or as a result of embryonic malformation and are composed of all layers of the esophageal wall. The presence of a Zenker diverticulum in a symptomatic patient represents always an indication for surgical therapy. A successful procedure contains a diverticulectomy combined with cervical myotomy. For the treatment of epiphrenic diverticula the underlying motility disorder, determined by preoperative manometry, plays a crucial role in the length of the myotomy. In order to prevent postoperative reflux a partial fundoplication should be added. Independent of location or size surgical therapy of diverticula of the esophagus has a success rate of more than 90 percent.
Theisen
J
J
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München. theisen@nt1.chir.med.tu-muenchen.de
Stein
H J
HJ
Siewert
J R
JR
D003937:Diagnosis, Differential; D004936:Diverticulum, Esophageal / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D004947:Esophagus / Q000601:surgery*; D006801:Humans