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Achalasia
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The esophageal hiatus is narrowed posteriorly to the esophagus by placing deep sutures through the crura of the diaphragm. The sutures are tied loosely to prevent them from cutting through, leaving sufficient space alongside the esophagus to allow passage of the tip of a finger. Two or three sutures may be required for this purpose (Figure 30.10).
Symptomatic Giant Hiatal Hernia with Intrathoracic Stomach
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
A hiatal hernia is an abnormal protrusion of some, or even all, of the stomach into the thoracic cavity via the esophageal hiatus. Hiatal herniae are subcategorized into four types. The overwhelming majority of hiatal herniae are type I (sliding), which involves displacement of the gastroesophageal junction above the esophageal hiatus but the fundus remaining in the abdomen. Type II (paraesophageal) involves herniation of the gastric fundus through the esophageal hiatus while the gastroesophageal junction remains at the level of the hiatus. Type III (mixed) is a combination of type I and type II herniae where both the gastroesophageal junction and the fundus have herniated into the chest. Type IV herniae can be any of the above but occur when other structures, such as colon or small bowel, are found in the hernia sac [1]. While generally presenting de novo, a proportion may be recurrent following previous attempted hiatal hernia repair or anti-reflux surgery.
The Chest
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
This is formed by the diaphragm with its various openings. This broad sheet of muscle with its large, trefoil-shaped central tendon has hiatuses through which pass the aorta, the oesophagus and the inferior vena cava, and is it innervated by the phrenic nerves. The oesophageal hiatus also contains both vagus nerves. The aortic hiatus contains the azygos vein and the thoracic duct.
A comprehensive motion analysis – consequences for high precision image-guided radiotherapy of esophageal cancer patients
Published in Acta Oncologica, 2021
Catharina T. G. Roos, Zohra Faiz, Sabine Visser, Margriet Dieters, Hans Paul van der Laan, Lydia A. den Otter, John T. M. Plukker, Johannes A. Langendijk, Antje-Christin Knopf, Christina T. Muijs, Nanna M. Sijtsema
Tumors located near the diaphragm are often highly mobile due to respiratory motion [6,7]. Balter et al. [8] reported that the diaphragm is an acceptable anatomical landmark for radiographic estimation of liver motion. The motion of inferiorly located lung cancers correlated well with the apex of the diaphragm [9]. The GEJ is normally located at the level of the esophageal hiatus of the diaphragm. The esophageal hiatus lies immediately anteriorly and slightly to the left, and is separated from the aortic hiatus by the decussation of the right crus of the diaphragm [10]. Therefore, we assume that the left side of the diaphragm is a good anatomic landmark for tumors located in the distal esophagus or in the GEJ.
Endoscopic measurement of hiatal hernias: is it reliable and does it have a clinical impact? Results from a large prospective database
Published in Postgraduate Medicine, 2023
Charles Christian Adarkwah, Oliver Hirsch, Merlissa Menzel, Joachim Labenz
Hiatal hernias are protrusions of abdominal parts into the mediastinum through the esophageal hiatus of the diaphragm [1]. They can be subdivided into four phenotypes: sliding hiatal hernias (type 1) and paraesophageal hernias (type 2–4) [2]. An intact gastroesophageal junction is composed of an overlapping lower esophageal sphincter and diaphragmatic crus (‘hiatus’). This barrier, if disrupted, can lead to increased gastroesophageal reflux and in turn symptoms and complications (GERD). The principal mechanism behind the development of a diaphragmatic hernia is a lax diaphragmatic hiatus and phreno-esophageal membrane [2,3].
Surgical treatment of therapy-resistant reflux after Roux-en-Y gastric bypass. A case series of the modified Nissen fundoplication
Published in Acta Chirurgica Belgica, 2020
Jan Colpaert, Julie Horevoets, Leander Maes, Gilles Uijtterhaegen, Bruno Dillemans
The original Nissen fundoplication was first performed by Dr. Rudolph Nissen in 1955. He published the results of two cases in an edition of the 1956 Swiss Medical Weekly [11]. In 1961, he published a more detailed overview of the procedure [12]. The main mechanism of the fundoplication is based on reinforcing the closing function of the lower esophageal sphincter (LES). The esophageal hiatus is also narrowed down by sutures to prevent or treat concurrent hiatal hernia.