Abstract
Background
3D computed tomography (CT) has been seldom used for the evaluation of hiatal hernias (HH) in surgical patients. This study aims to describe the 3D CT findings in candidates for laparoscopic or robotic antireflux surgery or HH repair and compare them with other tests.
Methods
Thirty patients with HH and/or gastroesophageal reflux disease (GERD) who were candidates for surgical treatment and underwent high-resolution CT were recruited. The variables studied were distance from the esophagogastric junction (EGJ) to the hiatus; total gastric volume and herniated gastric volume, percentage of herniated volume in relation to the total gastric volume; diameters and area of the esophageal hiatus.
Results
HH was diagnosed with CT in 21 (70%) patients. There was no correlation between the distance EGJ-hiatus and the herniated gastric volume. There was a statistically significant correlation between the distance from the EGJ to the hiatus and the area of the esophageal hiatus of the diaphragm. There was correlation between tomographic and endoscopic findings for the presence and size of HH. HH was diagnosed with manometry in 9 (50%) patients. There was no correlation between tomographic and manometric findings for the diagnosis of HH and between hiatal area and lower esophageal sphincter basal pressure. There was no correlation between any parameter and DeMeester score.
Conclusions
The anatomy of HH and the hiatus can be well defined by 3D CT. The EGJ-hiatus distance may be equally measured by 3D CT or upper digestive endoscopy. DeMeester score did not correlate with any anatomical parameter.
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Funding
Dr. Fernando Herbella was funded by CNPq, a Federal governmental funding Brazilian agency under #302838/2021-0.
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AVS, FAMH: conception and design, acquisition of data, analysis and interpretation of data, drafting the article, and final approval of the version to be published. CED, PV: conception and design, acquisition of data, and final approval of the version to be published. WCGMN, RPP, FDT: acquisition of data and final approval of the version to be published. RCK, MGP: review for intellectual content and final approval of the version to be published.
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Fernando Herbella was funded by CNPq, a Federal government funding Brazilian agency under #302838/2021-0. André V. Santana, Carlos E. Domene, Paula Volpe, William C. G. M. Neto, Rodrigo P. Polízio, Fernando D. Tamamoto, Rafael C. Katayama, and Marco G. Patti have no conflicts of interest or financial ties to disclose.
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Santana, A.V., Herbella, F.A.M., Domene, C.E. et al. High-resolution 3-dimensional tomography may be a useful tool for understanding the anatomy of hiatal hernias and surgical planning of patients eligible for laparoscopic or robotic antireflux surgery. Surg Endosc 38, 780–786 (2024). https://doi.org/10.1007/s00464-023-10599-5
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DOI: https://doi.org/10.1007/s00464-023-10599-5