A Reproducible Method of Measuring the Esophageal Hiatus and Potential Use in Hiatal Hernia Repairs

Esophageal hiatus closure during hiatal hernia repair is essential. Improper closure can lead to recurrence and high patient morbidity. Our aim is to introduce an easy and reproducible method of calculating the surface area (hiatal surface area [HSA]) of the esophageal hiatus. Standardization of this value will enable surgeons to have an evidence-based approach for hiatal hernia closure during laparoscopic repair.

We developed a measurement of HSA of the esophageal hiatus corresponding to a right-angle triangle: Area = (1/2) base × height. The height was defined as the left crus of the diaphragm. The base was defined as perpendicular to the crus and tangential to the medial edge of the esophagus. The mean esophageal hiatus surface area was calculated from deceased patients without a hiatal hernia undergoing full autopsies and compared to patients undergoing laparoscopic repair.

A total of 237 (37 cadaveric) hiatuses were measured. The median HSA defect in the cadaveric group was 1.97 cm² with an interquartile range (IQR) of 1.13 to 3.0 cm² was significantly larger compared to 5.0 cm² with an IQR of 3.5 to 7.5 cm² in the operative group (P < .001). Multivariate linear regression demonstrated an overall significant positive correlation between esophageal hiatus surface area defect and the variables of age and weight but not with gender.

This study demonstrated a new reproducible method of measurement for esophageal hiatus. The significant difference between the two groups suggests that our formula can be utilized to develop a standardized value for the surface area of the esophageal hiatus.