LAPAROSCOPIC ANATOMY OF THE REGION OF THE ESOPHAGEAL HIATUS

Background: The wide patient acceptance of hiatal and gastroesophageal surgery performed by laparoscopy has suddenly generated a large volum e of procedures frequently done by surgeons with limited experience in this area. This has resulted in an excessive number of complications. Knowledge of the normal and pathologic laparoscopic anatomy is essent ial for safe dissection around the esophageal hiatus. Methods: This de scription is based on the experience gained during 850 open and 150 la paroscopic surgeries in and around the hiatus and on the review of the literature. Results: Laparoscopic approach, dissection, and accessibi lity of the hiatus and surrounding organs are different than those exp erienced through cadaveric dissection and open surgeries. Conclusions: Clear understanding of the normal and pathologic anatomy and its vari ations facilitates laparoscopic dissection of the hiatus and neighbori ng structures and should help the surgeon avoid complications.