The esophageal hiatus: what is the normal size?

Shamiyeh, Andreas; Szabó, K; Granderath, Frank A.; Syré, G; Wayand, W.; Zehetner, Jörg

doi:10.1007/s00464-009-0711-0

Cited by 34 publications

(19 citation statements)

References 23 publications

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“…Batirel et al estimated that the expected HSA after crural repair should be 2.5–3.0 cm 2 , which is in agreement with our normal size [7]. Shamiyeh et al found mean HSA of 5.84 cm 2 among cadavers [15]. …”

Section: Discussionsupporting

confidence: 86%

“…Previous studies have approximated HSA using the geometric assumption that the hiatus is shaped like a slice of a circle whose area can be calculated after obtaining the radius and angle, a method first described by Granderath et al in 2007. [8–11, 13–15]. Others have estimated HSA by tracing the region of interest on an intra-operative image with a graphic software [7].…”

Section: Introductionmentioning

confidence: 99%

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

Ouyang

Dass²,

Zhao

et al. 2015

Surg Endosc

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Background Accurate measurement of esophageal hiatus size is clinically important, especially when antireflux surgery is planned. We present a novel method for in vivo measurement of esophageal hiatal surface area using MDCT multiplanar reconstruction. We aimed to determine if large hiatal area is associated with hiatal hernia and gastroesophageal reflux disease. Methods We retrospectively analyzed subjects prospectively enrolled in the COPDGene® project. We created two test groups, one with hiatal hernia on chest CT, and one with GERD on medical treatment identified by history without hernia. Matched control groups were formed. We performed CT post-processing to define the double oblique plane of the esophageal hiatus, on which the hiatal surface area is manually traced. Results 48 subjects with hernia had larger mean hiatus areas than matched controls (6.9 cm2 vs. 2.5 cm2, p<0.0001), and were more likely to have GERD (42% vs. 10%, p<0.0005). Subjects with mixed (type III) hernias had larger hiatuses compared to subjects with sliding (type I) hernias, who, in turn, had larger hiatuses than subjects without hernia (p<0.0001). 55 hernia-negative subjects with GERD did not have significantly larger mean hiatal areas compared to matched controls (3.0 cm2 vs. 2.5 cm2, p=0.12). 20 measurements obtained by two radiologists showed correlation of 0.93, with mean difference of 0.5 cm2 (p=0.20). Conclusions We devised a method to measure in vivo esophageal hiatal surface area using MDCT reconstruction and established the normal size range for the first time. This methodology has the potential to guide decision-making in antireflux surgery technique pre-operatively, and assess surgical result post-operatively. Presence of hernia correlated with large hiatuses and GERD. However, hiatal area failed to identify those with GERD in the absence of hiatal hernia.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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

Ouyang

Dass²,

Zhao

et al. 2015

Surg Endosc

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“…In our experience, the value of HSA in normal and in obese subjects (mean values: 4.19 and 3.92 cm 2 , respectively) was higher than those reported by Quyang (mean 2.5 cm 2 ), but similar to the dimensions found by other authors [2,3,14] while mean HSA was definitely larger in patients with demonstrated HH (mean 8.3 cm 2 ). As reported by Shamiyeh, a mean HSA of 5.84 cm 2 was found in the cadavers of overweight (BMI 27 kg/m 2 ) subjects [14] with no HH, but the difference might be explained by the physiological status of the tissues. Batirel proposed a postoperative value target of 2.5-3.0 cm 2 after the surgical reparation of the hiatal defect [2].…”

Section: Discussionsupporting

confidence: 87%

“…Granderath first introduced the concept of measuring the HSA in 2007 by using an adapted intraoperative formula [3]. It was then modified by others, who introduced further intraoperative measuring methods, all with the goal to offer a tailored approach, based on the HSA values, for the antireflux surgery, which could be simple cruroplasty, reinforced with mesh or tension-free with mesh [2,14,15]. Our intraoperative formula, although simplified, provides relatively the same measurement as Granderath's formula, with a small error that does not alter the results, as has been mathematically demonstrated above.…”

Section: Discussionmentioning

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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“…An exact anatomical determination of the normal size of the esophageal hiatus is lacking. Shamiyeh et al [31] recently published the first study in which the normal size of a patient's esophageal hiatus is determined. The normal values, ranging up to 4 cm 2 , from this study done on cadaver subjects reflect the correct thresholds used in a recent study for tailoring the crural closure technique [21].…”

Section: Discussionmentioning

confidence: 99%

Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty

et al. 2010

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The esophageal hiatus: what is the normal size?

Abstract: The mean HSA was determined in these normal subjects to be 5.84 cm(2). It was directly proportional to chest circumference and independent of height, weight, BMI, and gender.

Cited by 34 publications

References 23 publications

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

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

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

Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty

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