Article

Treatment of Pharyngo-Esophageal Diverticulum By Inversion Of The Sac*

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Abstract

IN 1895 Girard1 of France first reported treatment of pharyngo esophageal diverticulum by simple inversion. Subsequently Halstead2 and Bevan3 independently utilized the procedure and reported its success. Since that time, except for an occasional report such as that made by Ross,4 the technic has not been described in the literature and generally has been replaced by the technics of excision of the diverticulum as reviewed by Lahey,5 Harrington,6 and others.

A pharyngo-esophageal diverticulum is composed of mucosa and submucosa herniating through the zone of the junction of the pharynx and esophagus and through the triangular space bounded by the fibers of the cricopharyngeal muscle and the inferior constrictor of the pharynx. The position of the sac may be in the midline or usually to the left between the two muscles (fig. 1). The structure and relationship of the sac renders it possible to reduce the herniation by inversion of the sac and closure of the muscular defect. This procedure has been performed in a series of 11 consecutive cases of pharyngo-esophageal diverticula by the following technic:

Technic

  1. Unless the roentgenographic investigation demonstrates clearly that the diverticulum originates on the right side (which is rare) an incision is made through skin and platysma over the anterior edge of the left sternocleidomastoid muscle from the level of the hyoid bone to the suprasternal notch.

  2. The sternocleidomastoid and prethyroid muscles are retracted laterally and the lobe of the thyroid medially. To provide adequate exposure, it usually is necessary to ligate and. . .


 

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