The phrenoesophageal membrane

Abstract

Gross dissections and histologic study of the organs and tissues in the region of the esophageal hiatus in twenty-five fresh autopsy specimens reveal that the subperitoneal and subpleural tissue in this area is fascioareolar in nature. Its gross characteristic, when compressed by handling, causes it to appear membranous. Its microscopic appearance is that of loose areolar elastic tissue. Because of these findings it is thought to have the primary function of being a stroma through which nerve, vascular, and lymphatic structures pass. A secondary position-stabilizing function with marked variability, depending upon the quantity, elasticity, and state of atrophy, is admitted. A primary position-attachment significance of this tissue, based upon its strength or relationship to the esophagus or stomach, is doubted. It is well recognized that after the repair of the anatomic defect in a hiatus hernia, the space occupied by the fascioareolar tissue should be obliterated by attachment of peritoneum to the esophagus to prevent intra-abdominal structures from finding their way into the space a second time. It may be that the term, ligament, has come into common usage in the same way that the peritoneal folds of the posterior abdominal wall have been erroneously named ligaments. The ligament of Treitz and the splenorenal ligament are such examples. In the presence of a hernia the peritoneum at the phrenoesophageal position constitutes the sac. Surgeons should, therefore, recognize that when the sac has been removed and the peritoneum is reconstructed to the esophageal wall, it can in no way be considered ligamentous.