title: Predictability of hiatal hernia/defect size: is there a correlation between pre- and intraoperative findings?
abstract: OBJECTIVE
  Closure of the esophageal hiatus is an important step during laparoscopic antireflux surgery and hiatal hernia surgery. The aim of this study was to investigate the correlation between the preoperatively determined hiatal hernia size and the intraoperative size of the esophageal hiatus.
  
  
  METHODS
  One hundred patients with documented chronic gastroesophageal reflux disease underwent laparoscopic fundoplication. All patients had been subjected to barium studies before surgery, specifically to measure the presence and size of hiatal hernia. The size of the esophageal hiatus was measured during surgery by calculating the hiatal surface area (HSA). HSA size >5 cm(2) was defined as large hiatal defect. Patients were grouped according to radiologic criteria: no visible hernia (n = 42), hernia size between 2 and 5 cm (n = 52), and >5 cm (n = 6). A retrospective correlation analysis between hiatal hernia size and intraoperative HSA size was undertaken.
  
  
  RESULTS
  The mean radiologically predicted size of hiatal hernias was 1.81 cm (range 0-6.20 cm), while the interoperative measurement was 3.86 cm(2) (range 1.51-12.38 cm(2)). No correlation (p < 0.05) was found between HSA and hiatal hernia size for all patients, and in the single radiologic groups, 11.9 % (5/42) of the patients who had no hernia on preoperative X-ray study had a large hiatal defect, and 66.6 % (4/6) patients with giant hiatal hernia had a HSA size <5 cm(2).
  
  
  CONCLUSIONS
  The study clearly demonstrates that a surgeon cannot rely on preoperative findings from the barium swallow examination, because the sensitivity of a preoperative swallow is very poor.
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria, oliver.owen.koch@gmail.com.
authors.forename: O O
authors.initials: OO
authors.lastname: Koch
authors.forename: M
authors.initials: M
authors.lastname: Schurich
authors.forename: S A
authors.initials: SA
authors.lastname: Antoniou
authors.forename: G
authors.initials: G
authors.lastname: Spaun
authors.forename: A
authors.initials: A
authors.lastname: Kaindlstorfer
authors.forename: R
authors.initials: R
authors.lastname: Pointner
authors.forename: L L
authors.initials: LL
authors.lastname: Swanstrom
mesh_terms: D000328:Adult; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000601:surgery*; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011859:Radiography; D012189:Retrospective Studies