Laparoscopic anatomy of the region of the esophageal hiatus.

Background: The wide patient acceptance of hiatal and gastroesophageal surgery performed by laparoscopy has suddenly generated a large volume of procedures frequently done by surgeons with limited experience in this area. This has resulted in an excessive number of complications. Knowledge of the normal and pathologic laparoscopic anatomy is essential for safe dissection around the esophageal hiatus.

Methods: This description is based on the experience gained during 850 open and 150 laparoscopic surgeries in and around the hiatus and on the review of the literature.

Results: Laparoscopic approach, dissection, and accessibility of the hiatus and surrounding organs are different than those experienced through cadaveric dissection and open surgeries.

Conclusions: Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic dissection of the hiatus and neighboring structures and should help the surgeon avoid complications.