THE DIAPHRAGM has always acted as a barrier to the progress of upper abdominal surgery. As a result the structures in the region of the diaphragm, such as the lower portion of the esophagus and the cardiac end of the stomach, have been neglected surgically. This is partly due to the fact that the chest itself was not opened up to surgeons until comparatively recently. However, even after open thoracic operations were made safe, the diaphragm remained a barrier, so that surgeons argued the advantages of the transthoracic versus the abdominal approach to diaphragmatic hernia. Obviously, if no harm would come from traversing the diaphragm, it would be of tremendous advantage to be able to repair a diaphragmatic hernia with both the abdominal and the thoracic cavity open. The same applies to lesions of the lower part of the esophagus. In most of these lesions the site of the primary
HARPER FR. THORACICOABDOMINAL APPROACH TO UPPER PORTION OF ABDOMEN AND UPPER POLE OF KIDNEY. Arch Surg. 1947;54(5):517–528. doi:10.1001/archsurg.1947.01230070526003
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