Which of the following statements about epiphrenic diverticula of the esophagus is/are correct?

E. The operation of choice is a stapled diverticulectomy, long esophagomyotomy, and partial fundoplication.

DISCUSSION: Epiphrenic diverticula are pulsion diverticula that arise in the distal 10 cm. of the esophagus. The cause is elevated intraesophageal pressure, which forces mucosa and submucosa to herniate through the muscle layers. Though this may occur with an esophageal reflux stricture or tumor, primary disordered esophageal motility is the most common cause. Many patients are asymptomatic when their epiphrenic diverticula are diagnosed by barium esophagography, symptoms being related more to the degree of disordered motility than to the size of the pouch. Distal esophageal diverticulum is best approached through a left thoracotomy. When surgery is indicated, the preferred approach is transthoracic diverticulectomy using a surgical stapler, a long esophagomyotomy to relieve the elevated intraesophageal pressure, and a nonobstructing partial (e.g., Belsey's) fundoplication.