Crura ultrastructural alterations in patients with hiatal hernia: a pilot study

Abstract

The evidence of ultrastructural alterations in all the patients in the HH group raises the suspicion that the long-term outcomes of antireflux surgery depend not only on the surgical technique, but also on the underlying muscular diaphragmatic illness.

The Pathogenesis of Hiatal Hernia

“…In 2007, Fei et al reported muscular deterioration, including sarcolemmal alterations, subsarcolemmal vacuolar degeneration, extended disruption of sarcotubular complexes, increased intermyofibrillar spaces, and sarcomere splitting, in patients with GERD and a hiatal hernia compared to controls without a hiatal hernia. 18 In a follow-up study from 2009, the same group reported on 33 patients with GERD and a hiatal hernia undergoing laparoscopic repair and compared them to 15 control subjects without hiatal hernia undergoing laparoscopic cholecystectomy. 19 Tissue specimens from the PEL and crura revealed 94% of patients with a hiatal hernia to have muscular abnormalities of the crura, 75% with severe abnormalities, though none had abnormalities within the PEL, suggesting a muscular defect as the cause of hiatal herniation.…”

Antireflux Surgery with Routine Mesh Hiatoplasty

“…Collagen plays an important role in the development of inguinal and incisional hernias [7, 8] and there is also a possible relationship between collagen impairment and hiatal hernia [6]. There is evidence of ultrastructural alterations in patients with hiatal hernia; the long‐term results of antireflux surgery depend not only on the surgical technique but also on the underlying muscular diaphragmatic illness [9].…”