CT oesophageal hiatal surface area measurements: An objective and sensitive means of hiatal hernia detection

Abstract

BackgroundThere is no consensus on the best investigation for hiatal hernia (HH) diagnosis, and studies continue to demonstrate significant heterogeneity in results. CT hiatal surface area (HSA) measurement has been proposed as a method of measuring in vivo oesophageal hiatus preoperatively, but there is currently no evidence comparing the effectiveness of CT and HSA assessment with other preoperative investigations. MethodsA retrospective analysis of 287 consecutive patients (2005–2016) who underwent laparoscopic hiatal hernia (HH) repair. Preoperative investigations (endoscopy, barium swallow, high-resolution manometry, and standard CT reporting) and CT hiatal surface area (HSA) measurements were evaluated by two independent observations (radiologist and surgeon). ResultsOverall, sensitivity for preoperative HH detection was 75.3% (n = 259) for endoscopy, 77.4% (n = 106) for barium swallow, 70.9% (n = 110) for HRM and 80.4% (n = 56) for standard CT reporting. Preoperative sensitivity for CT HSA was 94.6% (n = 37). Mean CT HSA was significantly higher in the HH group compared to a 1:1 matched control group (8.7cm2 vs 2.2cm2, p < 0.01). The accuracy of the observers was identical at 94.6%, with an intra-class correlation coefficient of 1.00 (p < 0.01) demonstrating excellent reliability. ConclusionCT HSA is an objective and quantitative method of oesophageal hiatal assessment that may be more sensitive than traditional preoperative investigations for HH detection.