Cirugía Medicina Sociedad Venezolana
Surgical Anatomy in Bariatric Surgery (Part I)
PDF (Español (España))

Keywords

Cirugía bariátrica, anatomía quirúrgica, diafragma, esfínter esofágico inferior, ángulo de His, reflujo gastroesofágico, gastrectomía vertical, membrana frenoesofágica. Bariatric surgery, surgical anatomy, diaphragm, lower esophageal sphincter, angle of His, gastroesophageal reflux, sleeve gastrectomy, phreno-esophageal membrane

How to Cite

Tapia , . J. ., Valero F., F. Y. ., Navarrete A., S. A. ., Level, L. ., & Medina, D. . (2025). Surgical Anatomy in Bariatric Surgery (Part I). REVISTA VENEZOLANA DE CIRUGÍA, 78(2). https://doi.org/10.48104/RVC.2025.78.2.2

Abstract

Surgical anatomy is a fundamental pillar that supports the knowledge of every surgeon seeking success in their practice. However, it is not the only one; applying it in isolation, while ignoring elements such as physiology, pathophysiology, and the development of surgical skills, may lead to poor patient outcomes. This first part analyzes key structures in bariatric surgery located in the upper abdomen. The diaphragm, esophageal hiatus, phreno-esophageal membrane, abdominal esophagus, lower esophageal sphincter (LES), angle of His, Belsey fat pad, and gastro-phrenic ligament are described, highlighting their functional and surgical importance in relation to techniques such as sleeve gastrectomy and gastric bypass, with emphasis on implications like reflux and fistulas. This knowledge enables surgeons to optimize outcomes and prevent complications.

https://doi.org/10.48104/RVC.2025.78.2.2
PDF (Español (España))

References

O Korn Bruzzone y col. El diafragma, el hiato y la unión gastroesofágica. Rev Argent Cirug 2020;112(4):407-413. Disponible en: https://www.researchgate.net/publication/352112462_El_diafragma_el_hiato_y_la_union_gastroesofagica

Moreno-Egea A. Anatomía quirúrgica de los pilares del diafragma: consideraciones técnicas para la reparación de la hernia hiatal esofágica. Rev Hispanoam Hernia. 2018;6(1):53-58. Disponible en: https://hernia.grupoaran.com/index.php/articles/00084/show

Oliveira JJ, Herani B, Reis FP, Feitosa VLC, Aragao JA. Contribution towards the anatomy of the esophageal hiatus and its relationship with the presence of bundles of collagen fibers in its margins. Int J Morphol. 2012;30(3):858-865. Disponible en: https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-95022012000300015

Mittal RK. The crural diaphragm, an external lower esophageal sphincter: a definitive study. Gastroenterology. 1993;105(5):1565-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/8224664/

Libermann-Meffert D, Brauer R. Surgical anatomy of the distal esophagus and cardia. In: Wastell C, Nyhus L, Donahue P (editors). Surgery of the esophagus, stomach and small intestine. 5th edition. Boston: Little, Brown and Co; 1995. Pp 32- 44.

Oubiña J. Anatomía quirúrgica del esófago. Cirugía Digestiva, F. Galindo. www.sacd.org.ar, 2009; I-150, pág. 1-13. Disponible en: https://sacd.org.ar/wp-content/uploads/2020/05/ucincuenta.pdf

Zaninotto G, DeMeester TR, Schwizer W, Johansson KE, Cheng SC. The lower esophageal sphincter in health and disease. Am J Surg. 1988;155:104-11. Disponible en: https://pubmed.ncbi.nlm.nih.gov/3341525/

Melissas J, Braghetto I, Molina JC, Silecchia G, Iossa A, Iannelli A, Foletto M. Gastroesophageal Reflux Disease and Sleeve Gastrectomy. Obes Surg. 2015 Dec;25(12):2430-5. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26428250/

Caro Mendoza Álvaro. Reflujo gastroesofágico. Ayer, hoy y mañana*. rev. colomb. cir. 2004 Mar; 19( 1 ): 5-16. Disponible en: https://www.revistacirugia.org/index.php/cirugia/article/view/1379/1041

Cristiam Alexander Morales, Jonathan Alexis Sánchez1 , Brayan David Sánchez, Jean Pierre Vergnaud, Jesús Vásquez, Juan Pablo Toro. Relación entre gastrectomía de tipo manga y reflujo gastroesofágico. Rev Colomb Cir. 2016;31:128-35. Disponible en: https://www.revistacirugia.org/index.php/cirugia/article/view/264

Kleidi E, Theodorou D, Albanopoulos K, Menenakos E, Kar¬velis MA, Papailiou J, et al. The effect of laparoscopic sleeve gastrectomy on the antireflux mechanism: Can it be minimized? Surg Endosc. 2013;27:4625-30.

Harraca, . D. J. L., Grigaites, D. A. L., Martínez Duartez, P., Aguirre Ackermann, M., Quevedo, P., Musso, C., Fuentes, S., Salmeri, E., Calderón, G., Roussos, A., Farías, J. M., Ferraro, A. A., Bocanera, L., Lerner, M., Babor, E., Fernández, E., Deluca, L., & Gorodner, V. (2021). Consenso Argentino Intersociedades de Cirugía Bariátrica y Metabólica. Revista Argentina De Cirugía, 113(SUPLEMENTO 1), 1–70. Disponible en: https://aac.org.ar/consensoba.pdf

Bruzzi M, M'Harzi L, Poghosyan T, El Batti S, Zinzindohoué F, Chevallier JM, Douard R. Anatomical Relations Between the Esogastric Junction, the Diaphragm, the Pleura, and the Left Lung in Chronic Esogastro-bronchial and/or Esogastro-pleural Fistulas After Sleeve Gastrectomy. Obes Surg. 2019 Sep;29(9):2814-2823. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31069692/

Ferraz ÁAB, Feitosa PHF, Santa-Cruz F, Aquino MR, Dompieri LT, Santos EM, Siqueira LT, Kreimer F. Gastric Fistula After Sleeve Gastrectomy: Clinical Features and Treatment Options. Obes Surg. 2021 Mar;31(3):1196-1203. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33222105/

Lannelli A, Treacy P, Sebastianelli L, Schiavo L, Martini F. Perioperative complications of sleeve gastrectomy: Review of the literature. J Minim Access Surg. 2019 Jan-Mar;15(1):1-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29737316/

Ortega CB, Guerron AD, Yoo JS. The Use of Fluorescence Angiography During Laparoscopic Sleeve Gastrectomy. JSLS. 2018 Apr-Jun;22(2):e2018.00005. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC6016860/pdf/e2018.00005.pdf

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Copyright (c) 2025 REVISTA VENEZOLANA DE CIRUGÍA