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The crura of the diaphragm and diaphragmatic passage

Les piliers du diaphragme et la traversée diaphragmatique de l'œsophage. Applications au reflux gastro-œsophagien, a son exploration et à son traitement

Applications to gastroesophageal reflux, its investigation and treatment

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Summary

The authors report an anatomical, morphological and functional study on the diaphragmatic passage of the esophagus. This study allows to conclude that the anatomical structures of the region play an important role in gastroesophageal continence. The idea of “physiological sphincter” must be broadened and take into account the crura of the diaphragm which from a true extrinsic anatomic sphincter. The authors also insist on the dynamic aspect of this region and on the variations of pressure related to the respiratory movements. From a practical standpoint, the conclusions of this study should permit the surgeon to make a dynamic investigation of gastroesophageal reflux and adapt treatment to a more precise physiopathological mechanism.

Résumé

Les auteurs rapportent un travail anatomique, morphologique et fonctionnel, sur la traversée diaphragmatique de l'œsophage. Cette étude leur permet de conclure que la place réservée aux structures anatomiques dans la continence gastro-œsophagienne est importante. La notion de ≪ sphincter physiologique ≫ doit être élargie en tenant compte des piliers du diaphragme qui forment un véritable sphincter anatomique extrinsèque. Ils insistent sur l'aspect dynamique de cette région et sur les variations de pression en relation avec les mouvements respiratoires. Dans la pratique les conclusions de ce travail devraient permettre au chirurgien de faire une exploration dynamique du reflux gastro-œsophagien et d'adapter son geste à un mécanisme physiopathologique précis.

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Authors and Affiliations

  1. Faculté de Médecine, Laboratoire d'Anatomie, 51, rue Cognacq-Jay, 51095, Reims, France

    J. F. Delattre, A. Ducasse & J. B. Flament

  2. Clinique Chirurgicale, Hôpital Robert-Debré, rue Alexis-Carrel, 51092, Reims, France

    J. P. Palot

  3. Laboratoire d'Anatomie UER Biomédicale des Saints-Pères, 45, rue des Saints-Pères, 75270, Paris Cedex 06, France

    J. Hureau

Authors
  1. J. F. Delattre
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  2. J. P. Palot
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  3. A. Ducasse
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  4. J. B. Flament
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  5. J. Hureau
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Delattre, J.F., Palot, J.P., Ducasse, A. et al. The crura of the diaphragm and diaphragmatic passage. Anat. Clin 7, 271–283 (1985). https://doi.org/10.1007/BF01784644

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