Between 1969 and 1989, thirty-three patients were admitted for the treatment of a mid- or lower thoracic
diverticulum and were investigated. Their mean age was 63 years. The predominant symptoms were
dysphagia and regurgitations of, on average, 5.8 years' duration. Three patients had associated
carcinoma and were excluded from the study. Three patients with mild complaints were managed medically and 27 surgically. Surgical treatment included, prior to 1979, simple diverticulectomy in 10 patients since 1970 diverticulectomy and
myotomy through a right thoracic approach in one patient diverticulectomy, esophageal
myotomy and
fundoplication through a left thoracic approach in 10 patients and simple abdominal esophageal
myotomy with
fundoplication in 4 patients. In 2 patients, an esophagobronchial
fistula was successfully treated. There were 3 postoperative deaths (2
suture line leakages and one massive
aspiration pneumonia). Two patients had persistent
dysphagia: one was reoperated on for a subsequent abdominal esophageal
myotomy and the other one for severe
reflux esophagitis following esophageal dilatations. Four patients had
reflux esophagitis and two were reoperated on for a total duodenal diversion. The importance of the long esophageal
myotomy extended on to the cardia through a left
thoracotomy, and of a good antireflux procedure after the
myotomy, in the treatment of thoracic
esophageal diverticula is emphasized.