Several structures lying close to the esophageal hiatus of the diaphragm may be injured in surgical procedures on the hiatus. The anatomic proximity of the lower third of the esophagus to the right pleura creates the risk of accidental entrance into the pleural cavity during abdominal operations on the esophageal hiatus.
Hiatus hernia is a protrusion of a portion of the stomach into the thoracic mediastinum through the esophageal hiatus of the diaphragm. Anatomic descriptions and step-by-step technique are provided for the treatment of various types of hiatus hernia (sliding hiatus, paraesophageal hiatus, combined sliding and paraesophageal, congenital short esophagus, and traumatic diaphragmatic). Laparoscopic Nissen fundoplication has replaced the traditional open operation; newly revised material details this procedure.