Q All are true about Nissen’s fundoplication except?

a) It is a 360 degree fundoplication

b) Gas bloat syndrome is a common complication

c) Nissen's fundoplication can be done by both thoracic and abdominal approach

d) Usually three sutures are taken to hold the wrap

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Traction diverticula

Q) What is true about traction diverticula of the esophagus?

a) It is a common diverticulum at the lower end of esophagus

b) Most  of these diverticula are symptomatic and require surgery

c) Mediastinal fibrosis is a common etiologial factor

d) They are most common on the left side


c) Mediastinal fibrosis is a common etiological factor.

Traction diverticula are recognised by elongation of the diverticula becuase of pull from granulomatous inflamation from the surrounding tissues, most commonly lymph nodes.

Most of the traction diverticula are in mid esophagus on the right side 4-5 cm either side of carina.  The common etiological factors are mediastinal infections, tuberculosis, mediastinal fibrosis and histoplasmosis.

These are true traction diverticula and have all the walls of esophagus.

They are mostly discovered incidentally during the workup of other diseases. Most of these are asymptomatic but can present with dysphagia, chest pain and regurgitation.

Complications include bleeding or fistula formation with airway.

Surgical option - right  thoracotomy followed by excision of fistula and repair of esophagus in layers with correction of distal obstruction if present.

Ref: Shackelford Surgery 8th edition page 373