Intraoperative Measurement, Classification, And Abbreviated Description Of Hiatal Hernias

Abstract

Aim: Classification of hiatal hernias should include the main parameters for intraoperative selection of the surgical treatment method. Abbreviated descriptions of hiatal hernias, such as HH I-IV are not complete and need further development. Methods: We have perfected a classification of hiatal hernias and used it in clinical practice to classify hernias in 75 patients who underwent surgical treatment. Four recognized types of hiatal hernias (HH) were used. Type I (sliding) hernias have the gastroesophageal (GE) junction above the level of the diaphragmatic hiatus. Type II (rolling) hernias have a normally positioned GE junction, but a portion of the fundus is above the hiatus. Type III hernias have displacement of the GE junction and fundus above the hiatus and type IV hernias are characterized by the presence of other viscera within the hernia sac. The width (W) defect between the right and left diaphragmatic crura is the most important size measurement that determines the difficulty of successfully repairing the hiatal hernia, with W1 8 cm. The length (L) of the hernia defect was defined as the vertical distance in cm between the high and low point of hiatal orifice with L1 4 cm. We considered that hiatal hernia recurrence (R) after previous repair should be included in the classification with R0, no recurrence and R (n), the number of previous hernia repairs.Results: Our perfected classification was in the format: HH I-IV; W1-4; L1-3; SE 0-2; R 0-n. According to our data, the parameters of hiatal hernia were formulated in most cases (49/75) as HH I; W 2; L 2; SE 0; R 0, which represented the prevalence of patients with sliding hernia with secondary width and length of the esophageal orifice, without shortening esophagus or recurrence.Conclusions: Our classification allows abbreviated description of the main intraoperative parameters of hiatal hernia, which facilitates the choice of the surgical treatment method.