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Published on: September 11, 2021
Clinical relevance of laparoscopically diagnosed hiatal hernia
Yves Van Nieuwenhove1, Jeroen Sonck, Boudewijn De Waele
1Department of Surgery, Universitair Ziekenhuis Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium, hlkvney@uzbrussel.be.
Background:
To determine the clinical relevance of a laparoscopically diagnosed hiatal hernia.
Methods:
Consecutive patients undergoing an elective laparoscopy were prospectively recruited. We assessed preoperative gastroesophageal reflux symptoms using a validated score, and documented the presence or absence of a hiatal hernia during laparoscopy.
Results:
Of the 95 evaluable patients, 42 (44%) had a hiatal hernia. The mean age was 49.8 years. Logistic regression analysis indicated that three features were significantly and independently associated with hiatal hernia: a higher reflux score (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.48-4.05; p < 0.001), low body mass index (BMI) (OR 0.83; 95% CI 0.70-0.98; p = 0.029), and type of surgery (OR 0.34; 95% CI 0.14-0.92; p = 0.033). The diagnostic accuracy of a reflux score of more than 2 was 81%, with a sensitivity, specificity, positive predictive value, and negative predictive value of 76%, 85%, 80%, and 82%, respectively. The likelihood ratio for a positive result was 5.05.
Conclusion:
Hiatal hernia is common in this population of surgical patients undergoing an elective laparoscopy. Patients with reflux symptoms or a low BMI were more likely to have a hiatal hernia. With a reflux score of more than 2, the probability of finding a hiatal hernia during laparoscopy is 80%.
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