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.

Etiopathogenesis and classification of esophageal diverticula.

The classification and etiopathogenesis of esophageal diverticula is discussed on the basis of our experience with the surgical management of 74 such diverticula (51 parapharyngeal, 7 thoracic, 167 epiphrenic). Parapharyngeal diverticula always represent true diverticula, their walls comprising muscular tissue as well as mucosa and submucosa. A causal relationship between esophageal reflux disease and Zenker's diverticulum has not yet been proved. Thoracic diverticula are probably more often of a congenital than traction origin. Epiphrenic diverticula result either from hypertonia of the lower esophageal sphincter (esophageal achalasia) or, if the latter functions normally, are of congenital origin. Traction etiology can in special cases be due to the presence of a leiomyoma in the esophageal wall.

[Surgical treatment of functional disorders of the esophagus in the aged]. / Zur Problematik der chirurgischen Behandlung von Funktionsstörungen der Speiseröhre im Alter.

From 1948 to 1980, 747 patients with functional disorders of the esophagus were operated on at the First Department of Surgery of the Medical Faculty, Palacky University in Olomouc. In 177 (24%) of them, the intervention was performed at an older age. The gerontosurgical problem was especially evident in patients with esophageal diverticula of whom 40 to 51.1% were older than 60 years. In patients with paraesophageal and mixed hiatal hernias, it was 45%. However, in very complicated cases of achalasia and reflux diseases, it was also often necessary to operate older patients. The applicability of some surgical techniques and tactics in older patients has been discussed.