LAPAROSCOPIC TECHNIQUE FOR MEASURING THE ESOPHAGEAL HIATUS AREA

Abstract

Introduction. The measurement of the esophageal hiatus (EH) area is critical for the choice of the method of hernioplasty for EH hernias. Aim. The objective of this study was to develop a laparoscopic method and tools for measuring the EH area and to compare it with existing methods in type III paraesophageal hernias (PEH). Materials and methods. Laparoscopic hernioplasty was performed on 63 patients with type III PEH – 41.3% males and 58.7% females, with an average age of 53.8±10.8 years, at the surgical clinic of the Bogomolets National Medical University. Irreducible PEH was present in 54 (85.7%) patients, partially reducible in 9 (14.3%). Cardia-fundal PEH was found in 42 (66.7%) patients, subtotal in 20 (31.7%), and total in 1 (0.6%) patient. The average volume of the hernial sac, according to multispiral computed tomography (MSCT), was 235±130.7 cm³ (ranging from 90 cm³ to 863 cm³). In all patients, the EH area was measured using the developed laparoscopic method (DLM) and tools; the Granderath method; the rhomboid area determination method (RAD); and MSCT. The authors evaluated the differences in the mean value and mean percentage difference (MPD) of EH area measurements between the mentioned methods. Results. The esophageal hiatus area measured using the DLM was statistically smaller than that measured by MSCT: 9.66±0.22 cm² versus 13.01±3.04 cm², respectively, and larger than the measurements from the Granderath method and the RAD: 8.16±1.71 cm² and 8.72±1.67 cm², respectively. The MPD between the MSCT data and the Granderath and RAD methods were 40.1±7.5% and 68.8±9.6%, respectively; between MSCT and DLM, it was 28.8±7.4%. The percentage difference in the esophageal hiatus area between the MSCT data and DLM, MSCT and Granderath, and MSCT and RAD showed a significantly positive correlation with the volume of the hernial sac, respectively r=0.687, r=0.601, and r=0.579. This indicates that with an increase in the volume of the hernial sac, the esophageal hiatus area calculated by MSCT increases compared to the intraoperative methods, likely due to the influence of the hernial contents on the area of the hernial orifice. Conclusions. The proposed laparoscopic method for measuring the area of the EH involves the use of a developed device that facilitates the removal of hernial contents from the hernial orifice, placing a ruler in their plane as a reference, transmitting the image to a computer, and calculating the area taking into account the individual shape characteristics. This method provides more accurate data compared to other intraoperative techniques and MSCT. Using the proposed laparoscopic technique for measuring the EH area will allow for a more thorough assessment of the indications for different hernioplasty options, considering the area of the hernial defect.