, Volume 18, Issue 6, pp 883–888 | Cite as

Predictability of hiatal hernia/defect size: is there a correlation between pre- and intraoperative findings?

  • O. O. KochEmail author
  • M. Schurich
  • S. A. Antoniou
  • G. Spaun
  • A. Kaindlstorfer
  • R. Pointner
  • L. L. Swanstrom
Original Article



Closure of the esophageal hiatus is an important step during laparoscopic antireflux surgery and hiatal hernia surgery. The aim of this study was to investigate the correlation between the preoperatively determined hiatal hernia size and the intraoperative size of the esophageal hiatus.


One hundred patients with documented chronic gastroesophageal reflux disease underwent laparoscopic fundoplication. All patients had been subjected to barium studies before surgery, specifically to measure the presence and size of hiatal hernia. The size of the esophageal hiatus was measured during surgery by calculating the hiatal surface area (HSA). HSA size >5 cm2 was defined as large hiatal defect. Patients were grouped according to radiologic criteria: no visible hernia (n = 42), hernia size between 2 and 5 cm (n = 52), and >5 cm (n = 6). A retrospective correlation analysis between hiatal hernia size and intraoperative HSA size was undertaken.


The mean radiologically predicted size of hiatal hernias was 1.81 cm (range 0–6.20 cm), while the interoperative measurement was 3.86 cm2 (range 1.51–12.38 cm2). No correlation (p < 0.05) was found between HSA and hiatal hernia size for all patients, and in the single radiologic groups, 11.9 % (5/42) of the patients who had no hernia on preoperative X-ray study had a large hiatal defect, and 66.6 % (4/6) patients with giant hiatal hernia had a HSA size <5 cm2.


The study clearly demonstrates that a surgeon cannot rely on preoperative findings from the barium swallow examination, because the sensitivity of a preoperative swallow is very poor.


GERD Hiatal hernia Esophageal hiatus Reflux symptoms Fundoplication 


Conflict of interest

Oliver Owen Koch, Matthias Schurich, Stavros A. Antoniou, Georg Spaun, Adolf Kaindlstorfer, Frank A. Granderath, Rudolph Pointner and Lee L. Swanstrom have no conflict of interest or financial ties to disclose. All authors do disclose all institutional or corporate/commercial relationships going back 36 months and longer.


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Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • O. O. Koch
    • 1
    • 2
    Email author
  • M. Schurich
    • 3
  • S. A. Antoniou
    • 2
  • G. Spaun
    • 1
  • A. Kaindlstorfer
    • 2
  • R. Pointner
    • 2
  • L. L. Swanstrom
    • 4
  1. 1.Department of General and Visceral SurgerySisters of Charity HospitalLinzAustria
  2. 2.Department of General SurgeryGeneral Hospital Zell am SeeZell am SeeAustria
  3. 3.Department of RadiologyGeneral Hospital Zell am SeeZell am SeeAustria
  4. 4.Division of Gastrointestinal and Minimally Invasive SurgeryThe Oregon ClinicPortlandUSA

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