How is surgical tx of diffuse esophageal spasm?

Surgical treatment • Thoracic esophagomyotomy including all circular muscle fibers from GE junction to above arch of Ao. • Inclusion of LES is controversial +/- antireflux • Success rate 50-60% • Indications: • Incapacitating DES (severe dysphagia, chest pain..) • Pulsion diverticulum Left lateral thoracotomy (between 6th and 7th ribs) Resection of an epiphrenic diverticulum and concomitant thoracic esophagomyotomy on the opposite wall. Secured under water seal to check for mucosal injury