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September 1959

Surgical Anatomy of the Diaphragm

Author Affiliations

From the Surgical Service, Wood Veterans Administration Hospital, and the Department of Surgery, Marquette University School of Medicine.

AMA Arch Surg. 1959;79(3):468-478. doi:10.1001/archsurg.1959.04320090116017

Introduction  The importance of diaphragmatic function and wholeness in relationship to pulmonary and gastrointestinal physiology has been well documented. A "second look" at the structure and action of the diaphragm has been warranted, however, because of recent stress on the surgical aspects of esophageal hiatal hernias and the clinical appearance of pathologic syndromes related to diaphragmatic malfunction following thoracic surgical procedures. A study of the dynamic anatomy of the diaphragm was therefore undertaken, and the results of this investigation with its clinical applications are herein reported.

Methods of Study  The diaphragm and attached phrenic nerves were studied in situ and in the fresh state after complete excision in 25 postmortem specimens. Photographs and drawings were utilized to record pertinent findings.Observations on diaphragmatic motion were made on eight patients undergoing transthoracic repair of a hiatus hernia after dissection of the hiatus and crura. In addition, two patients were carefully evaluated

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