Sub-diaphragmatic fascia: role in the recurrence of hiatal hernias

One of the most common causes of a failed Nissen fundoplication is disruption of the crural repair. We investigated the thickness of the subdiaphragmatic fascia overlying the right and left limb of the right crus in cadavers to determine any difference. Sub-diaphragmatic fascia specimens were obtained from three sites adjacent to the hiatus in 20 preserved cadavers. One square centimeter of fascia was excised 3 cm from the arch of the hiatus on each side and approximately 2-3 mm from the edge of the hiatal opening (labeled RL and LPL). A third sample was taken 1 cm from the arch of the hiatus on the left side (labeled LAL). The thickness of these tissues was measured. The mean tissue thickness of RL, LPL and LAL were 0.22 mm, 0.23 mm and 0.4 mm, respectively. There was no difference in tissue thickness between the lower specimens on both sides (RL vs. LPL); however, LAL was significantly thicker than both RL and LPL (P < 0.05). The thickness of the subdiaphragmatic fascia overlying the right and left limb of the right crus does not differ significantly in the region used for crus closure during antireflux surgery; however, the fascia on the left is thicker anteriorly.