THE LIFETIME MORPHOMETRY OF CARDIOESOPHAGEAL TRANSITION IN PATIENTS WITH HIATAL HERNIA
https://doi.org/10.20340/mv-mn.2022.30(3).657
Abstract
With the development of X-ray technology and the advent of computed tomography, it became possible not only to accurately diagnose hiatal hernia, but also to conduct morphometry of all its constituent anatomical structures in different projections to use the data obtained at the stage of preoperative planning for its surgical treatment. Currently, due to the improvement in the quality of diagnostics, there is an increase in the detection of patients with this pathology, along with this, the question of choosing the most rational method of treatment is acute. The aim of the study was to study the computed tomographic anatomy of the structures of the cardioesophageal junction in patients with hiatal hernia. A retrospective study of a series of computed tomograms in 53 patients with hiatal hernia, performed on a 64-slice Canon Aquilion Prime tomograph, was carried out. An assessment was made of the diameter of the distal esophagus, the size of the hernia orifice, and the deviation of the axis of the esophagus at the level of the hernial orifice relative to the diaphragm in two planes. As a result of the analysis, it was found that in 79% of cases the esophagus was located on the right and behind the hernial sac, in 13% - behind and in the middle, in 8% - on the left and behind. It was revealed that the diameter of the unchanged part of the esophagus above the hernial sac was 20.9±3.71 mm (min – 15.7 mm, max – 30.2 mm). The dimensions of the hernial orifice varied within 31.21±5.23 mm in the frontal plane (min - 24.7 mm, max - 42 mm) and 32.66±4.36 mm in the sagittal plane (min - 26.2 mm, max - 39.1 mm). The deviation of the axis of the esophagus in the frontal plane was 63.53°±16.74 (min - 19.6°, max - 92.3°). The deviation of the axis of the esophagus in the sagittal plane was 74.12°±21.31 (min - 36.3°, max - 118.1°). Thus, due to the variability in the structure and location of the anatomical structures of the cardioesophageal zone in patients with hiatal hernia, it is necessary to take into account all of the above indicators, including the presence or absence of large branches of the greater omentum in the hernial sac, body type, gender, age of patients, which serves an integral part of preoperative planning of surgical treatment, optimization and reduction of complications, as well as determining the safest method of its surgery.
About the Authors
Sergey N. LyashchenkoRussian Federation
Professor, Doctor of Medical Sciences, Professor of the Professor Mikhailov Department of Operative Surgery and Clinical Anatomy
Competing Interests:
The author declares that he did not have any conflicts of interest in the planning, implementation, financing and use of the results of this study
Dmitry B. Demin
Russian Federation
Doctor of Medical Sciences, Professor, Head of Faculty Surgery Department
Competing Interests:
The author declares that he did not have any conflicts of interest in the planning, implementation, financing and use of the results of this study
Ivan N. Borodkin
Russian Federation
Head of the Endoscopy Department of the Pirogov City Clinical Hospital; Assistant of the Department of Faculty Surgery of the Orenburg State Medical University
Competing Interests:
The author declares that he did not have any conflicts of interest in the planning, implementation, financing and use of the results of this study
Dmitry V. Savin
Russian Federation
Candidate of Medical Sciences, Deputy of Chief Doctor, of the Pirogov City Clinical Hospital; Assistant of the Department of Faculty Surgery of the Orenburg State Medical University
Competing Interests:
The author declares that he did not have any conflicts of interest in the planning, implementation, financing and use of the results of this study
Anush R. Nikogosyan
Russian Federation
Studentin
Competing Interests:
The author declares that she did not have any conflicts of interest in the planning, implementation, financing and use of the results of this study
Nadezhda S. Bokareva
Russian Federation
Radiologist
Competing Interests:
The author declares that she did not have any conflicts of interest in the planning, implementation, financing and use of the results of this study
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Supplementary files
The variability of the structure and topography of the anatomical structures of the cardioesophageal zone requires taking into account the type of physique, gender, age in patients with hiatal hernia for planning, optimizing and reducing complications, choosing a safe method of surgical treatment
Review
For citations:
Lyashchenko S.N., Demin D.B., Borodkin I.N., Savin D.V., Nikogosyan A.R., Bokareva N.S. THE LIFETIME MORPHOMETRY OF CARDIOESOPHAGEAL TRANSITION IN PATIENTS WITH HIATAL HERNIA. Morphological newsletter. 2022;30(3):16-23. (In Russ.) https://doi.org/10.20340/mv-mn.2022.30(3).657