STEP 5Myotomy

The cricopharyngeus muscles are divided and bluntly dissected from the mucosa. Myotomy of the pars transversa and of the upper esophagus is performed.

After myotomy several options exist, depending on the size of the diverticulum.

Small diverticula measuring up to 2 cm virtually disappear after the myotomy is completed and may be left alone or fixed cranially with the apex. They may be inverted and sutured to the prevertebral fascia, which prevents food retention without necessitating creation of a staple line or suture line that is at risk for fistula formation (A).

Larger diverticula are resected with a linear stapler parallel to the esophageal lumen, taking care not to compromise the diameter of the esophagus (B-1, B-2). Alternatively, open resection and closure with a running suture is performed.

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