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Surgical Anatomy of the Diaphragm

Surgical Anatomy of the Diaphragm Abstract Introduction The importance of diaphragmatic function and wholeness in relationship to pulmonary and gastrointestinal physiology has been well documented. A "second look" at the structure and action of the diaphragm has been warranted, however, because of recent stress on the surgical aspects of esophageal hiatal hernias and the clinical appearance of pathologic syndromes related to diaphragmatic malfunction following thoracic surgical procedures. A study of the dynamic anatomy of the diaphragm was therefore undertaken, and the results of this investigation with its clinical applications are herein reported. Methods of Study The diaphragm and attached phrenic nerves were studied in situ and in the fresh state after complete excision in 25 postmortem specimens. Photographs and drawings were utilized to record pertinent findings.Observations on diaphragmatic motion were made on eight patients undergoing transthoracic repair of a hiatus hernia after dissection of the hiatus and crura. In addition, two patients were carefully evaluated References 1. Listerud, M. B., and Harkins, H. N.: Anatomy of the Esophageal Hiatus , A. M. A. Arch. Surg. 76:835 ( (May) ) 1958.Crossref 2. Jordan, E. H., and Kindred, E. J.: Textbook of Embryology , Ed. 5, New York, D. AppletonCentury-Crofts, Inc., 1948, pp. 151-156. 3. Maier, H. C., and Ehler, A. A.: Esophagus After Pneymonectomy , J. Thoracic Surg. 9:220 ( (Dec.) ) 1939. 4. Barrett, N. R.: Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 45:279, 1952. 5. Collis, J. L., Satchwell, L. M., and Abrams, L. D.: Nerve Supply to the Crura of the Diaphragm , Thorax 9:22 ( (March) ) 1954.Crossref 6. Steele, J. D.: Personal communication to the authors. 7. Langston, H. T.: Personal communication to the authors. 8. Gale, J. W.: Personal communication to the authors. 9. Pickhardt, O. C.; Rafsky, H. A., and Ghiselin, F. H.: Treatment of Hiatus Hernia in Older Persons , J. A. M. A. 142:310 ( (Feb. 4) ) 1950.Crossref 10. Lam, C. R., and Kenney, L. J.: Problem of the Hiatus Hernia of the Diaphragm , J. Thoracic Surg. 27:1 ( (Jan.) ) 1954. 11. Marchand, P.: The Anatomy of the Esophageal Hiatus of the Diaphragm and the Pathogenesis of Hiatus Herniation , J. Thoracic Surg. 37:81 ( (Jan.) ) 1959. 12. Allison, P. R.: Reflux Esophagitis, Sliding Hiatal Hernia, and the Anatomy of Repair , Surg. Gynec. & Obst. 92:419 ( (April) ) 1951. 13. Carey, J. M., and Hollinshead, W. H.: Anatomy of the Esophageal Hiatus Related to Repair of Hiatal Hernia , Proc. Staff Meet. Mayo Clin. 30:223, 1955. 14. Rives, J. D., and Baker, D. D.: Anatomy of the Attachments of the Diaphragm: Their Relation to the Problems of the Surgery of Diaphragmatic Hernia , Ann. Surg. 115:745, 1942. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

Surgical Anatomy of the Diaphragm

ZIMBERG, YALE H.; WEISEL, WILSON
A.M.A. Archives Surgery , Volume 79 (3) – Sep 1, 1959
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References (13)

Publisher
American Medical Association
Copyright
Copyright © 1959 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1959.04320090116017
Publisher site
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Abstract

Abstract Introduction The importance of diaphragmatic function and wholeness in relationship to pulmonary and gastrointestinal physiology has been well documented. A "second look" at the structure and action of the diaphragm has been warranted, however, because of recent stress on the surgical aspects of esophageal hiatal hernias and the clinical appearance of pathologic syndromes related to diaphragmatic malfunction following thoracic surgical procedures. A study of the dynamic anatomy of the diaphragm was therefore undertaken, and the results of this investigation with its clinical applications are herein reported. Methods of Study The diaphragm and attached phrenic nerves were studied in situ and in the fresh state after complete excision in 25 postmortem specimens. Photographs and drawings were utilized to record pertinent findings.Observations on diaphragmatic motion were made on eight patients undergoing transthoracic repair of a hiatus hernia after dissection of the hiatus and crura. In addition, two patients were carefully evaluated References 1. Listerud, M. B., and Harkins, H. N.: Anatomy of the Esophageal Hiatus , A. M. A. Arch. Surg. 76:835 ( (May) ) 1958.Crossref 2. Jordan, E. H., and Kindred, E. J.: Textbook of Embryology , Ed. 5, New York, D. AppletonCentury-Crofts, Inc., 1948, pp. 151-156. 3. Maier, H. C., and Ehler, A. A.: Esophagus After Pneymonectomy , J. Thoracic Surg. 9:220 ( (Dec.) ) 1939. 4. Barrett, N. R.: Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 45:279, 1952. 5. Collis, J. L., Satchwell, L. M., and Abrams, L. D.: Nerve Supply to the Crura of the Diaphragm , Thorax 9:22 ( (March) ) 1954.Crossref 6. Steele, J. D.: Personal communication to the authors. 7. Langston, H. T.: Personal communication to the authors. 8. Gale, J. W.: Personal communication to the authors. 9. Pickhardt, O. C.; Rafsky, H. A., and Ghiselin, F. H.: Treatment of Hiatus Hernia in Older Persons , J. A. M. A. 142:310 ( (Feb. 4) ) 1950.Crossref 10. Lam, C. R., and Kenney, L. J.: Problem of the Hiatus Hernia of the Diaphragm , J. Thoracic Surg. 27:1 ( (Jan.) ) 1954. 11. Marchand, P.: The Anatomy of the Esophageal Hiatus of the Diaphragm and the Pathogenesis of Hiatus Herniation , J. Thoracic Surg. 37:81 ( (Jan.) ) 1959. 12. Allison, P. R.: Reflux Esophagitis, Sliding Hiatal Hernia, and the Anatomy of Repair , Surg. Gynec. & Obst. 92:419 ( (April) ) 1951. 13. Carey, J. M., and Hollinshead, W. H.: Anatomy of the Esophageal Hiatus Related to Repair of Hiatal Hernia , Proc. Staff Meet. Mayo Clin. 30:223, 1955. 14. Rives, J. D., and Baker, D. D.: Anatomy of the Attachments of the Diaphragm: Their Relation to the Problems of the Surgery of Diaphragmatic Hernia , Ann. Surg. 115:745, 1942.

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A.M.A. Archives Surgery – American Medical Association

Published: Sep 1, 1959

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