[Anatomical features and biomechanical properties of the diaphragm in pathogenesis of hiatal hernia].

Objective: To study changes of diaphragm and esophageal-diaphragmatic junction depending on age and constitutional features.

Material And Methods: We studied changes of diaphragm and esophageal-diaphragmatic junction depending on age and constitutional features by using of 40 cadaveric specimens (people aged 19-75 years).

Results: Esophageal-aortic ligament is observed rarer with age. This ligament is poorly developed in brachiomorphic body type while diaphragmatic-cardiac ligament is generally absent as a rule. This is a predisposing factor for weakening this area. It was revealed that reduced strength and elasticity (especially esophageal-aortic and esophageal-diaphragmatic ligaments) is one of the key factors in the development of hiatal hernia. It is especially relevant for brachiomorphic body type, the 2 mature and elderly age. The 2 mature period is associated with reduced diameter and kinking of great arteries, that leads to 1.5-2 times decrease of arterial capacity of the diaphragm. Therefore, hiatal hernia repair using own tissues may be insufficient and accompanied by recurrence in persons with brachiomorphic body type in the 2 mature period.

Conclusion: Analysis of biomechanical data and anatomical features of the diaphragm may be useful to predict recurrent hiatal hernia.