The crura of the diaphragm and diaphragmatic passage. Applications to gastroesophageal reflux, its investigation and treatment.

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.