The modifications suffered by the peri-esophageal anatomical structures in the hiatal hernia disease: a qualitative and quantitative microanatomic study.

This paper presents the results of a surgical and histopathological study regarding the microanatomical modifications of the thoraco-abdominal diaphragm and of the peri-esophageal structures in the hiatal hernias, establishing a cause-effect relationship between these structural modifications and the hiatal hernia. The study was represented by two groups of patients: a control group and a group with hiatal hernia. The study method consisted in intraoperatory biopsy of fragments from the diaphragm as well as from the tissue around the esophagus, which were studied from the histopathological viewpoint, using histological methods and quantitative microanatomy. In the end, the results obtained from the two groups were compared. The microscopic examination revealed the presence of an inflammatory infiltrate located between muscle fibers, especially near blood vessels, at the level of the diaphragm crura and the phreno-esophageal membrane. Also, they found red blood cell at this level, most likely due to pressure from the hernia at this level. From the quantitative micro-anatomical viewpoint, there has been noticed an increase in the percent of the vascular lumen (accentuated vasodilatation) as well as the interstices occupied with the edema and hemorrhage, to the detriment of the muscle fibers, the most significant modifications being met at the level of the crura.