The classification of hiatal shapes and their use as a marker for complexity, operative interventions, and recurrence

Diaphragmatic reconstruction is a vital, but challenging component of hiatal hernia and antireflux surgery. Results are optimized by minimizing axial tension along the esophagus, assessed with intra-abdominal length, and radial tension across the hiatus, which has not been standardized. We categoriz...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2024-10, Vol.28 (10), p.1578-1585
Main Authors: Campbell, John M., Ivy, Megan L., Farivar, Alexander S., White, Peter T., Bograd, Adam J., Louie, Brian E.
Format: Article
Language:English
Subjects:
Adult
Aged
Antireflux surgery
Diaphragm
Diaphragm - surgery
Female
Hernia, Hiatal - classification
Hernia, Hiatal - surgery
Herniorrhaphy - methods
Hiatal hernia
Hiatal shape
Humans
Male
Middle Aged
Paraesophageal hernia
Recurrence
Retrospective Studies
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Summary:Diaphragmatic reconstruction is a vital, but challenging component of hiatal hernia and antireflux surgery. Results are optimized by minimizing axial tension along the esophagus, assessed with intra-abdominal length, and radial tension across the hiatus, which has not been standardized. We categorized hiatal openings into 4 shapes, as a surrogate for radial tension, to correlate their association with operative interventions and recurrence. We retrospectively reviewed all primary hiatal hernias (≥3 cm) repaired at a single center between 2010 and 2020. Patients with intraoperative hiatal photos with at least 1 year of follow-up were included. The hiatal openings were classified into 4 shapes: slit, inverted teardrop, “D,” and oval, and ordered in this manner of hypothesized increased complexity and tension. A total of 239 patients were studied, with 113 (47%) having a recurrence. Age (P 
ISSN:1091-255X
1873-4626
1873-4626
DOI:10.1016/j.gassur.2024.07.003