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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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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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Authors and Affiliations

  1. Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria

    O. O. Koch & G. Spaun

  2. Department of General Surgery, General Hospital Zell am See, 5700, Zell am See, Austria

    O. O. Koch, S. A. Antoniou, A. Kaindlstorfer & R. Pointner

  3. Department of Radiology, General Hospital Zell am See, 5700, Zell am See, Austria

    M. Schurich

  4. Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, OR, USA

    L. L. Swanstrom

Authors
  1. O. O. Koch
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  2. M. Schurich
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  3. S. A. Antoniou
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  4. G. Spaun
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  5. A. Kaindlstorfer
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  6. R. Pointner
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  7. L. L. Swanstrom
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Correspondence to O. O. Koch.

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Koch, O.O., Schurich, M., Antoniou, S.A. et al. Predictability of hiatal hernia/defect size: is there a correlation between pre- and intraoperative findings?. Hernia 18, 883–888 (2014). https://doi.org/10.1007/s10029-012-1033-z

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  • DOI: https://doi.org/10.1007/s10029-012-1033-z

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