CT oesophageal hiatal surface area measurements: an objective and sensitive means of hiatal hernia detection - 18/03/23

Doi : 10.1016/j.soda.2023.100085

Daniel L Chan ^1,^2,^3,^⁎ , Brenda W Huang ¹, Jim Yip ², Manish Chug ^1,³, Jim Iliopoulos ^1,², Annemarie Hennessy ², Michael L Talbot ^1,^2,³
¹ Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
² School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
³ Saint George and Sutherland Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia

^⁎Corresponding author: Dr. Daniel L Chan, Suite 3, Level 5, Saint George Private Hospital, 1 South Street, Kogarah NSW 2217, Australia. Tel: (612) 9553 1120Saint George Private HospitalSuite 3, Level 5 1 South StreetKogarahNSW2217Australia

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Highlights

•	A retrospective analysis of 287 consecutive patients (2005-2016) who underwent laparoscopic hiatal hernia (HH) repair. Preoperative investigations and CT hiatal surface area (HSA) measurements were evaluated.
•	Overall, sensitivity for preoperative HH detection was 75.3% (n=259) for endoscopy, 77.4% (n=106) for barium swallow, 70.9% (n=110) for HRM and 80.4% (n=56) for standard CT reporting. Preoperative sensitivity for CT HSA was 94.6% (n=37).
•	Mean CT HSA was significantly higher in the HH group compared to a 1:1 matched control group (8.7cm² vs 2.2cm², p < 0.01).
•	The accuracy of independent radiologist and surgeon observers was the same at 94.6%, with an intra-class correlation coefficient of 1.00 (p < 0.01) demonstrating excellent reliability.

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Abstract

Background

There is no consensus on the best investigation for hiatal hernia (HH) diagnosis, and studies continue to demonstrate significant heterogeneity in results. CT hiatal surface area (HSA) measurement has been proposed as a method of measuring in vivo oesophageal hiatus preoperatively, but there is currently no evidence comparing the effectiveness of CT and HSA assessment with other preoperative investigations.

Methods

A retrospective analysis of 287 consecutive patients (2005-2016) who underwent laparoscopic hiatal hernia (HH) repair. Preoperative investigations (endoscopy, barium swallow, high-resolution manometry, and standard CT reporting) and CT hiatal surface area (HSA) measurements were evaluated by two independent observations (radiologist and surgeon).

Results

Overall, sensitivity for preoperative HH detection was 75.3% (n=259) for endoscopy, 77.4% (n=106) for barium swallow, 70.9% (n=110) for HRM and 80.4% (n=56) for standard CT reporting. Preoperative sensitivity for CT HSA was 94.6% (n=37). Mean CT HSA was significantly higher in the HH group compared to a 1:1 matched control group (8.7cm2 vs 2.2cm2, p < 0.01). The accuracy of the observers was identical at 94.6%, with an intra-class correlation coefficient of 1.00 (p < 0.01) demonstrating excellent reliability.

Conclusion

CT HSA is an objective and quantitative method of oesophageal hiatal assessment that may be more sensitive than traditional preoperative investigations for HH detection.

Le texte complet de cet article est disponible en PDF.

Plan

INTRODUCTION

MATERIALS AND METHODS

Population

Inclusion and Exclusion criteria

	Authors initial: Chan DL, Huang BW, Yip J, Chug M, Iliopoulos J, Hennessy A, Talbot ML.
	No conflicts of interest to declare. DLC is the recipient of the RACS – Sir Roy McCaughey Surgical Research Fellowship, 2020-21 and AVANT Doctor in Training Research Scholarship 2021.