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      El diafragma, el hiato y la unión gastroesofágica Translated title: The diaphragm, the hiatus and the gastroesophageal junction

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          Abstract

          RESUMEN La unión del tubo esofágico con el estómago en lo que denominamos el cardias, su tránsito y relacio nes con el hiato diafragmático, las estructuras fibromembranosas que la fijan y envuelven, la existencia de un esfínter gastroesofágico anatómico y su real morfología, así como la interacción de todos estos elementos, han sido materia de controversia por décadas y aún hoy. Este artículo actualiza la descrip ción de tales estructuras.

          Translated abstract

          ABSTRACT The point where the esophagus connects to the stomach, known as the cardia, its transition and re lationship with the diaphragmatic hiatus, its fibromembranous attachments, the existence of an ana tomic gastroesophageal sphincter and its real morphology, and the interaction between all these ele ments, have been subject of debate for decades that still persist. The aim of this article is to describe the updated information of such structures.

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          Most cited references17

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          Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients.

          Laparoscopic sleeve gastrectomy has been accepted as an option for surgical treatment of obesity. After surgery, some patients present reflux symptoms associated with endoscopic esophagitis, therefore PPI's treatment must be indicated. This study aims to evaluate the manometric characteristic of the lower esophageal sphincter (LES) before and after sleeve gastrectomy This prospective study includes 20 patients submitted to esophageal manometry in order to determine the resting pressure, and total and abdominal LES length before and after the sleeve gastrectomy. Statistical variations on the LESP were validated according to Student's "t" test. Seventeen female and three male patients were included, with a mean age of 37.6 +/- 12.6 years. All patients reduced their body weight, from an initial BMI of 38.3 kg/m(2) to 28.2 kg/m(2) 6 months after surgery. No postoperative complications were observed in these patients. Preoperative mean LESP was 14.2 +/- 5.8 mmHg. Postoperative manometry decreased in 17/20 (85%), with a mean value of 11.2 +/- 5.7 mmHg (p = 0.01). Seven of them presented LESP <12 mmHg and ten patients <6 mmHg after the operation. Furthermore, the abdominal length and total length of the high pressure zone at the esophagogastric junction were affected. A sleeve gastrectomy produces an important decrease in LES pressure, which can in turn cause the appearance of reflux symptoms and esophagitis after the operation due to a partial resection of the sling fibers during the gastrectomy.
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            Surgical embryology and anatomy of the diaphragm with surgical applications.

            This article reviews the development, surgical anatomy, and teratology of the diaphragm, and discusses the diagnostic procedures, surgical therapy, and prognosis of congenital disturbances. Special attention is paid to the traumatic rupture of the diaphragm, concerning incidence, cause, diagnosis, prognosis, and surgical repair.
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              Surgical conditions of the diaphragm: anatomy and physiology.

              The diaphragm (Greek: dia = in-between, phragma = fence) is a musculoaponeurotic structure that serves as the most important respiratory muscle and the separating structure between the abdominal and thoracic cavities. This article reviews the anatomic components of the diaphragm, its pivotal role in respiration and in the gastroesophageal mechanism, and the surgical implications of the anatomic structuring.
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                Author and article information

                Journal
                racir
                Revista argentina de cirugía
                Rev. argent. cir.
                Asociación Argentina de Cirugía (Cap. Fed., , Argentina )
                2250-639X
                2250-639X
                December 2020
                : 112
                : 4
                : 407-413
                Affiliations
                [1] orgnameHospital Clínico Universidad de Chile orgdiv1Departamento de Cirugía Chile
                Article
                S2250-639X2020000400407 S2250-639X(20)11200400407
                10.25132/raac.v112.n4.ankor
                727b614e-c8ef-421e-b5c6-37e280c4383e

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 7
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                SciELO Argentina

                Categories
                Artículo original

                Function,Diafragma,Hiato,Unión gastroesofágica,Anatomía,Fisiología,Función,Diaphragm,Hiatus,Gastroesophageal junction,Anatomy,Physiology

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