Direct septum transversum incision to replace circumferential diaphragmatic incision in operations on the cardia.

Application of a simple anatomic approach to lesions of the cardia, both benign and malignant, in consecutive patients has demonstrated an excellent exposure with the same flexibility as the standard, circumferential, diaphragmatic, and abdominal incision used for the past 50 years. The technical details of the procedure and its application are described, along with the pertinent embryology, anatomy, and physiology that led to this approach.