Clinical relevance of laparoscopically diagnosed hiatal hernia.
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.


CONCLUSIONS
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%.
Van Nieuwenhove
Yves
Y
Department of Surgery, Universitair Ziekenhuis Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium, hlkvney@uzbrussel.be.
Sonck
Jeroen
J
De Waele
Boudewijn
B
Potvlieghe
Peter
P
Delvaux
Georges
G
Haentjens
Patrick
P
D000328:Adult; D000368:Aged; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology*; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies