World Journal of Laparoscopic Surgery

Register      Login

VOLUME 15 , ISSUE 2 ( May-August, 2022 ) > List of Articles

ORIGINAL RESEARCH

Intraoperative Measurement of Esophageal Hiatus Normal Area Size in Patients without Hiatus Hernia or Gastroesophageal Reflux Disease

Amir K Abosayed, Mohamed Saber Mostafa, Ahmed Maher Hassan, Ahmed Yahia Abdel Dayem

Keywords : Esophageal hiatus, Intraoperative, Normal size

Citation Information : Abosayed AK, Mostafa MS, Hassan AM, Dayem AY. Intraoperative Measurement of Esophageal Hiatus Normal Area Size in Patients without Hiatus Hernia or Gastroesophageal Reflux Disease. World J Lap Surg 2022; 15 (2):95-98.

DOI: 10.5005/jp-journals-10033-1522

License: CC BY-NC 4.0

Published Online: 16-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Untreated gastroesophageal reflux disease (GERD) and the associated reflux esophagitis have been negatively impacting the quality of life to a great extent. Data about the normal size of the hiatus opening seems to be prophylactic against the possible anti-reflux surgery postoperative wrap herniation into the thorax that occurs as a result of inadequate crural closure or its disrupted closure. This study aimed at determination of normal size of esophageal hiatus in adults, in an attempt to improve the outcome of anti-reflux surgeries. Patients and methods: This is a prospective study that was conducted on adult patients consecutively scheduled for abdominal surgery, either open or laparoscopic. Intraoperatively, a calibrated 36-French bougie with a balloon was introduced to the stomach through the mouth. The diameter of the balloon was measured when it was insufflated with the maximum volume that could pass through the hiatus. Results: Esophageal hiatus area ranged from 2 cm to 6.6 cm2 with a mean value of 3.8 cm2. No significant difference was found between males and females in the measured parameters (p >0.05). No significant correlation was found between the hiatus surface area and the patient's age, height, weight, BMI, chest circumference, or the esophageal parameters (p >0.05). Conclusion: This study reported a new mean value of the normal hiatus surface area in order to give a hand in improving the anti-reflux surgery outcome. Further studies on a large cohort are needed to estimate normal variations in regard to age and sex to help in improvement of anti-reflux surgery outcome.


PDF Share
  1. Karl HF, Benjamin B, Wolfarm B, et al. EASE recommendations for the management of gastroesophageal reflux disease. Surg Endosc 2014;28(6):1753–1773. DOI: 10.1007/s00464-014-3431-z.
  2. Takahashi T, Yoshida M, Kubota T, et al. Morphologic analysis of gastroesophageal reflux diseases in patients after distal gastrectomy. World J Surg 2005;29(1):50–57. DOI: 10.1007/s00268-004-7415-3.
  3. Liu DS, Tog C, Lim HK, et al. Delayed gastric emptying following laparoscopic repair of very large hiatus hernias impairs quality of life. World J Surg 2018;42(6):1833–1840. DOI: 10.1007/s00268-017-4362-3.
  4. Le Page PA, Furtado R, Hayward M et al. Durability of giant hiatus hernia repair in 455 patients over 20 years. Ann R Coll Surg Engl 2015;97(3):188–193. DOI: 10.1308/003588414X14055925060839.
  5. Koetje JH, Irvine T, Thompson SK, et al. Quality of life following repair of large hiatal hernia is improved but not influenced by use of mesh: results from a randomized controlled trial. World J Surg 2015;39(6):1465–1473. DOI: 10.1007/s00268-015-2970-3.
  6. Loukas M, Wartmann ChT, Tubbs RS, et al. Morphologic variation of the diaphragmatic crura: a correlation with pathologic processes of the esophageal hiatus? Folia Morphol (Warsz) 2008;67(4):273–279. PMID: 19085868.
  7. Shamiyeh A, Szabo K, Granderath FA, et al. The esophageal hiatus: what is the normal size? Surg Endosc 2010;24(5):988–991. DOI: 10.1007/s00464-009-0711-0.
  8. Koch OO, Asche KU, Berger J, et al. Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty. Surg Endosc 2011;25(4):1024–1030. DOI: 10.1007/s00464-010-1308-3.
  9. Ouyang W, Dass C, Zhao H, et al. Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD. Surg Endosc 2016;30(6):2465–2472. DOI: 10.1007/s00464-015-4499-9.
  10. Koch OO, Spaun G, Antoniou SA, et al. Endoscopic grading of the gastroesophageal flap valve is correlated with reflux activity and can predict the size of the esophageal hiatus in patients with gastroesophageal reflux disease. Surg Endosc 2013;27(12):4590–4595. DOI: 10.1007/s00464-013-3071-8.
  11. Moten AS, Ouyang W, Hava S, et al. In vivo measurement of esophageal hiatus surface area using MDCT: description of the methodology and clinical validation. Abdom Radiol 2020;45(9):2656–2662. DOI: 10.1007/s00261-019-02279-7.
  12. Granderath FA, Schweiger UM, Pointner R. Laparoscopic antireflux surgery: tailoring the hiatal closure to the size of hiatal surface area. Surg Endosc 2007;21(4):542–548: DOI: 10.1007/s00464-006-9041-7.
  13. Grubnik VV, Malynovskyy AV. Laparoscopic repair of hiatal hernias: new classification supported by long-term results. Surg Endosc 2013;27(11):4337–4346. DOI: 10.1007/s00464-013-3069-2.
  14. Koch OO, Kaindlstorfer A, Antoniou SA, et al. Influence of the esophageal hiatus size on the lower esophageal sphincter, on reflux activity and on symptomatology. Dis Esophagus 2012;25(3):201–208. DOI: 10.1111/j.1442-2050.2011.01238.x.
  15. Batirel HF, Uygur-Bayramicli O, Giral A, et al. The size of the esophageal hiatus in gastroesophageal reflux pathophysiology: outcome of intraoperative measurements. J Gastrointest Surg 14(1):38–44. DOI: 10.1007/s11605-009-1047-8.
  16. Koch OO, Schurich M, Antoniou SA, et al. Predictability of hiatal hernia/defect size: is there a correlation between pre- and intraoperative findings? Hernia 2014;18(6):883–888. DOI: 10.1007/s10029-012-1033-z.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.