Measurement of the esophageal hiatus by calculation of the hiatal surface area (HSA). Why, when and how?

  title={Measurement of the esophageal hiatus by calculation of the hiatal surface area (HSA). Why, when and how?},
  author={Frank Alexander Granderath},
  journal={Surgical Endoscopy},
I read with great pleasure the ‘‘Letters to the editor’’ by Dr. Fourtanier and Dr. Reardon [1,2] regarding the problem of hiatal closure and particularly the definition and measurement of the hiatal defect. [] Key Method For measurement of the hiatal defect, an endoscopic ruler is brought intrabdominally. Firstly, the length of the crura is measured in centimetres beginning at the crural commisure up to the edge where the Pars flaccida begins (radius R).
Hiatal surface area as a basis for a new classification of hiatal hernia
This study instigates the ongoing discussion on the definition of large and giant hiatal hernia and challenges the traditional classification by dividing a cohort of 658 patients into three groups, according to the HSA, and provided detailed information on methodology and outcomes.
Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD
Hiatal area failed to identify those with GERD in the absence of hiatal hernia, but has the potential to guide decision-making in antireflux surgery technique preoperatively, and assess surgical result postoperatively.
Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty
In primary intervention, recurrence of hiatal hernia is more likely the larger the HSA is, and the size of the hiatus is a major contributing factor to the possibility of reherniation.
Predictability of hiatal hernia/defect size: is there a correlation between pre- and intraoperative findings?
The study clearly demonstrates that a surgeon cannot rely on preoperatively determined hiatal hernia size and the intraoperative size of the esophageal hiatus, because the sensitivity of a preoperative swallow is very poor.
Mesh placement for hiatal hernia repair: can we solve the controversy?
The introduction of synthetic mesh (SM) reinforcement, could ameliorate the results and several studies have reported lower recurrence rates with its use and biological meshes have been proposed as an alternative although with conflicting results regarding efficacy.
Preoperative measurement of the hiatal surface with MDCT: impact on surgical planning
The overall reproducibility of MDCT HSA measurement was excellent and independently of reader’s experience HSA can be accurately measured on MDCT images, and the preoperative measurement of HSA has potential advantages for surgeons in terms of correct approach to hiatal defects in obese patient.
Hiatal Surface Area's CT scan measurement is useful in hiatal hernia's treatment of bariatric patients
  • C. Boru, M. Rengo, G. Silecchia
  • Medicine
    Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy
  • 2019
Preliminary results demonstrate MDCT scan HSA measurements as a valid, non-invasive method to predict intraoperative findings and allows the HSA monitoring in order to correlate the symptoms onset and failure of cruroplasty.
Influence of the esophageal hiatus size on the lower esophageal sphincter, on reflux activity and on symptomatology.
Although patients subjectively are not significantly affected by the size of the hiatus, it has significant effects on the LES pressure and on gastroesopageal reflux in supine position, and there was a significant positive correlation between HSA size and number of refluxes in supines position.
Videoendosurgical interventions are the operations of choice in the treatment of patients with large  and  giant  EHH and the most effective method of plasty for large and giant EHH is the combined plasty of the esophageal hiatus.
Functional Results after Repair of Large Hiatal Hernia by Use of a Biologic Mesh
It can be concluded that a biological mesh may be an alternative to synthetic meshes to reduce recurrences at least for up to 2 years, and local fibrosis and thickening of the mesh can affect the outcome being associated with abdominal discomfort despite a successful repair.


A new method to calibrate the hiatus
In his opinion studies would be required to compare this ideal diameter with the results of others in order to find the ideal tradeoff between preventing intrathoracic migration and postoperative dysphagia, and that calibration seems essential: it should be reproducible for all surgeons.
A modest proposal
  • P. Reardon
  • Medicine
    Surgical Endoscopy And Other Interventional Techniques
  • 2005
All surgeons performing closure of the hiatus as part of a hiatal hernia repair or fundoplication should measure the diameter of the pause both before and after closure, to alleviate the problem of impossible to tell exactly how tightly the crura were closed in the initial or subsequent operations.
Laparoscopic antireflux surgery: Tailoring the hiatal closure to the size of hiatal surface area
Measurement of HSA with subsequent tailoring of the hiatal closure to the hiotal defect is an effective procedure to prevent hiatAL hernia recurrence and/or intrathoracic wrap migration in laparoscopic antireflux surgery.
A modest proposal...
...for the perfection of nature.