Hiatal Surface Area's CT scan measurement is useful in hiatal hernia's treatment of bariatric patients

Abstract

Introduction: Hiatal surface area (HSA) measurement has been recently proposed as useful tool for tailored treatment of hiatal defects. Multidetector CT scan (MDCT) of the hiatal area was shown to be useful in hiatal hernia (HH) management. Purpose: MDCT preoperative HSA measurements validation as a useful method in the surgical repair decision making process of hiatal defects in candidates to antireflux ± bariatric surgery. Material and methods: Twenty-five obese patients (group A), candidates to laparoscopic cruroplasty ± bariatric surgery, were prospectively evaluated preoperatively and after one year, using an original MDCT algorithm, compared with intraoperative HSA measurement. Twelve nonobese (group B) and 12 obese patients (group C), without GERD or HH, were used as control groups. Results: Median preoperative HSA was 7.9 cm 2 , (interquartile IQR 5.97-9.80) while intraoperative median HSA was 6 cm 2 (6-9.5), p ¼ .84. Postoperative median HSA was 3.8 cm 2 (3.21-4.8), showing the efficacy of cruroplasty, comparable with HSA calculated in the control groups (3.98 for B and 3.69 cm 2 for C, p ¼ .8547). No statistically significant difference between MDCT preoperative measurement and intraoperative findings was observed. Conclusions: Preliminary results demonstrate MDCT scan HSA measurements as a valid, noninvasive method to predict intraoperative findings. It allows the HSA monitoring in order to correlate the symptoms onset and failure of cruroplasty.

Measurement of hiatal surface area and other hiatus oesophageal diameters at computed tomography imaging in patients with gastroesophageal reflux disease and its relationship with hiatal hernia

“…The difficulty of evaluation of intra-operative hiatus oesophagus and insufficient measurement technique made HSA measurement difficult. In the same study, a significant decrease in HSA dimensions was observed in 1 st -year control the thorax and abdominal CT.[ 21 ]…”

“…[ 4 19 20 ] This study has one of the largest case numbers in the literature. [ 4 20 21 ] Besides, our study has the second largest number of cases in the literature regarding the evaluation of hiatus oesophagus measurements with CT imaging. [ 4 ] We determined the relationship between GERD and HH with more data by measuring other diameters besides HSA.…”

Preoperative measurement of the hiatal surface with MDCT: impact on surgical planning

“…Then, the major horizontal distance between the two crura, including their thickness, is measured (S). With these two values, a simplified rhomboid formula was used as previously described [ 21 , 22 ] (Fig. 5 ).…”

Concomitant hiatal hernia repair during bariatric surgery: does the reinforcement make the difference?

“…There is also no consensus on the exact hernia size that should be repaired with a mesh as the definition of hernia size varies across studies. Pre-or intraoperative assessment of the hiatal surface area (hSa) was recently proposed, 11 due to a positive association between increasing hSa, increasing recurrence risk and therefore a higher need for mesh. a simplified, already established calculation of the hSa as a rhombus area was introduced, measuring the major horizontal distance between the two crura (d1) and the vertical distance between the pillars' decussation and the hiatus' superior edge (d2); hSa=d1Xd2/2 12 (Figure 1).…”

“…Briefly, the surgical technique of concomitant hhr during laparoscopic bariatric surgery was usually performed before the particular bariatric technique and consisted in full exposure of the hiatal area, hh reduction, abdominalization of the esophagus for at least 3 cm and hSa intraoperative measurement. 11,22 Patients with sliding hh and hSa <4 cm 2 underwent simple PC with interrupted nonabsorbable sutures (Prolene ® polypropylene 1/0, ethicon endosurgery, New Brunswick, NJ, uSa), while patients with larger hiatal defect (>4 cm 2 ) and pillars' weakness underwent on-lay mesh-reinforced PC (Figure 1a-C). Mesh was tailored to 8/7 cm, cutting the left part of the mesh, creating a hole in the up-etiology of hh, such as ultrastructural changes of the crura 12 or pharyngoesophageal ligament can lead to hiatoplasty disruption.…”