The muscular layer is closed over the mucosal staple line with interrupted 3-0 sutures.
A 2- to 3-cm incision is made into the abdomen through the phreno-esophageal ligament at the anterior margin of the hiatus along the midlateral border of the left crus. A tongue of gastric fundus is pulled up into the chest. This exposes the gastroesophageal junction and its associated fat pad. The fat pad is excised.
A longitudinal myotomy is performed along the anterior wall of the esophagus (opposite side to the diverticulum) from approximately 1 cm above the diverticulum extending down for about 1-2cm into the musculature of the stomach.
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