Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD

Ouyang, Wei; Dass, Chandra; Zhao, Huaqing; Kim, Cynthia; Criner, Gerard J.; Investigators, COPDGene

doi:10.1007/s00464-015-4499-9

Cited by 35 publications

(41 citation statements)

References 24 publications

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“…The large hiatal hernias were anatomically classified as types III and IV and clinically as type 2dII according to Koch et al ( 7 ). Using the formula given by Granderath ( 8 ), the hiatal surface area was calculated intraoperatively as 13.5 ± 4.5 cm 2 , which is well in the range of large mixed-type hiatal hernia ( 9 ).…”

Section: Methodsmentioning

confidence: 99%

Functional Results after Repair of Large Hiatal Hernia by Use of a Biologic Mesh

2016

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BackgroundThe aim of this observational study is to analyze the results of patients with large hiatal hernia and upside-down stomach after surgical closure with a biological mesh (Permacol®, Covidien, Neustadt an der Donau, Germany). Biological mesh is used to prevent long-term detrimental effects of artificial meshes and to reduce recurrence rates.MethodsA total of 13 patients with a large hiatal hernia and endothoracic stomach, who underwent surgery between 2010 and 2014, were included. Interviews and upper endoscopy were conducted to determine recurrences, lifestyle restrictions, and current complaints.ResultsAfter a mean follow-up of 26 ± 18 months (range: 3–58 months), 10 patients (3 men, mean age 73 ± 13, range: 26–81 years) were evaluated. A small recurrent axial hernia was found in one patient postoperatively. Dysphagia was the most common complaint (four cases); while in one case, the problem was solved after endoscopic dilatation. In three cases, bloat and postprandial pain were documented. In one case, an explantation of the mesh was necessary due to mesh migration and painful adhesions. In one further case with gastroparesis, pyloroplasty was performed without success. The data are compared to the available literature. It was found that dysphagia and recurrence rates are unrelated both in biological and in synthetic meshes if the esophagus is encircled. In series preserving the esophagus at least partially uncoated, recurrences after the use of biological meshes relieve dysphagia. After the application of synthetic meshes, dysphagia is aggravated by recurrences.ConclusionRecurrence is rare after encircling hiatal hernia repair with the biological mesh Permacol®. Dysphagia, gas bloat, and intra-abdominal pain are frequent complaints. Despite the small number of patients, it can be concluded that a biological mesh may be an alternative to synthetic meshes to reduce recurrences at least for up to 2 years. Our study demonstrates that local fibrosis and thickening of the mesh can affect the outcome being associated with abdominal discomfort despite a successful repair. The review of the literature indicates comparable results after 2 years with both biologic and synthetic meshes embracing the esophagus. At the same point in time, reconstruction with synthetic and biologic materials differs when the esophagus is not or only partially encircled in the repair. This is important since encircling artificial meshes can erode the esophagus after 5–10 years.

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Section: Methodsmentioning

confidence: 99%

Functional Results after Repair of Large Hiatal Hernia by Use of a Biologic Mesh

2016

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“…Quyang presented a new method for the in vivo measurement of HSA using multiplanar, multislice MDCT to demonstrate a better correlation between HH and GERD, due to an enlarged HSA [10]. This was a retrospective study on 1,190 subjects that underlined a certain advantage of the procedure: the MDCT scan with 3 D reconstruction was performed during a physiological status of the area (not during meals or strain maneuver), without the distension induced by the pneumoperitoneum, the relaxation induced by the anesthesia and the surgical dissection of the surrounding tissues during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, there is a low correlation between the standard preoperative investigations such as barium swallow and the intraoperative findings for the HSA dimensions, the herniated stomach volume as well as the weakness of the pillars, even though demonstrated by a few studies [9]. Recently, the evaluation and measurement of the HSA using multidetector computer tomography (MDCT) scan with multiplanar reconstruction was proposed to determine the range of the normal HSA, HSA in obese patients, and the value of the HSA after surgical repair [10]. The MDCT scan was shown to be more accurate than conventional imaging in the evaluation of post LSG complications that may lead to revision surgery, including transhiatal sleeve migration [11].…”

Section: Introductionmentioning

confidence: 99%

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

Boru¹,

Rengo

Iossa³

et al. 2019

Minimally Invasive Therapy & Allied Technologies

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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.

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“…Batirel et al [16] estimated in 2009 and Koch et al [17] confirmed in 2012 that a large hiatus area correlated with diminished LOS pressure and increased acid reflux in patients with GORD. Therefore, the preoperative measurement (scaling) of the hiatal hernia and oesophageal hiatus using CT is clinically important, especially when anti-reflux surgery is planned [18]. CT scan with Sengstaken-Blakemore tube provocation test as a preoperative diagnostic method can accurately confirm or exclude the diagnosis of any hiatal hernias, and can also reveal and describe subtle anatomical abnormalities in the OGJ region, such as dehiscence of diaphragm crura, thinning and shortening of the LES, the appearance of phreno-oesophageal membrane stretches, and displacement of the gastrooesophageal junction.…”

Section: Discussionmentioning

confidence: 99%

New method of preoperative selection of patients with gastro-oesophageal reflux disease

Panko¹,

Zhurbenka²,

Karpitski³

et al. 2019

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Introduction: The identification of sliding hiatal hernia (SHH) less than 3 cm in size using barium swallow fluoroscopy (BSF) and oesophagogastroduodenoscopy (OGD) was recently noted as a non-reliable method, allowing for approximately 2 cm of inherent error in its size estimate. Aim of the research: We aimed to develop a reliable method, which could be used for preoperative visualisation and accurate anatomic depiction of any hiatal hernia and anatomical abnormalities in patients with incomplete gastro-oesophageal reflux disease (GORD) symptom remission after appropriate medical therapy. Material and methods: Within the period 2015-2017, 29 GORD patients (15 women, mean age 51 years) with incomplete symptom resolution on acid inhibition and equivocal findings as for SHH after endoscopy and/or BSF, were evaluated before laparoscopic anti-reflux surgery (LARS) using a computed tomography scan with a Sengstaken-Blakemore tube (CTSBT) provocation probe to confirm hernia existence. We calculated the sensitivity of each of these diagnostic tests. Results: SHH was diagnosed in 21 patients by OGD and/or BSF, but during the surgery this diagnosis was confirmed in 18 patients. The sensitivity was found to be significantly higher in CTSBT modality, comparing with each of the other diagnostic tests and even higher than in OGD and BSF together. Conclusions: CTSBT has been verified as the most efficient method to confirm or rule out SHH diagnosis or other anatomical abnormalities, which could be used to provide a surgeon with detailed information while making a decision about the advisability of LARS. Streszczenie Wprowadzenie: Rozpoznawanie wślizgowej przepukliny rozworu przełykowego (SHH) o rozmiarze mniejszym niż 3 cm z zastosowaniem fluoroskopii z barytem (BSF) i ezofagoduodendoskopii (OGD) zostało ostatnio uznane za mało wiarygodną metodę, pozwalającą na ok. 2 cm błędu w oszacowaniu jej wielkości. Cel pracy: Opracowanie metody, która może być wykorzystana do przedoperacyjnej wizualizacji i dokładnego anatomicznego obrazowania SHH i innych nieprawidłowości anatomicznych u pacjentów z chorobą refluksową przełyku (GORD). Materiał i metody: W latach 2015-2017 u 29 pacjentów (15 kobiet, średni wiek: 51 lat) z niepełną remisją GORD po odpowiedniej terapii lekowej, u których wcześniej zdiagnozowano GORD i podejrzewano SHH na podstawie wyników endoskopii i/lub BSF, wykonano tomografię komputerową z zastosowaniem sondy Sengstaken-Blakemore (CTSBT) przed laparoskopową operacją antyrefluksową (LARS) w celu potwierdzenia obecności przepukliny. Różnicę czułości testów diagnostycznych obliczono za pomocą testu McNemar's Chi-square. Wyniki: Przepuklinę rozpoznano u 21 pacjentów za pomocą OGD i/lub BSF, chociaż w trakcie operacji rozpoznanie potwierdzono tylko u 18 pacjentów. Czułość diagnostyczna była znacznie wyższa w zakresie modalności CTSBT, gdy porównano ją z każdym z pozostałych testów diagnostycznych, a nawet wyższa niż w OGD i BSF razem. New method of preoperative selection of patients with gastro-oesophageal reflux disease Med...

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Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD

Cited by 35 publications

References 24 publications

Functional Results after Repair of Large Hiatal Hernia by Use of a Biologic Mesh

Functional Results after Repair of Large Hiatal Hernia by Use of a Biologic Mesh

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

New method of preoperative selection of patients with gastro-oesophageal reflux disease

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