Hiatal Surface Area's CT scan measurement is useful in hiatal hernia's treatment of bariatric patients

Abstract

Introduction

Hiatal surface area (HSA) measurement has been recently proposed as useful tool for tailored treatment of hiatal defects. Multidetector CT scan (MDCT) of the hiatal area was shown to be useful in hiatal hernia (HH) management.

Purpose

MDCT preoperative HSA measurements validation as a useful method in the surgical repair decision making process of hiatal defects in candidates to antireflux ± bariatric surgery.

Material and methods

Twenty-five obese patients (group A), candidates to laparoscopic cruroplasty ± bariatric surgery, were prospectively evaluated preoperatively and after one year, using an original MDCT algorithm, compared with intraoperative HSA measurement. Twelve non-obese (group B) and 12 obese patients (group C), without GERD or HH, were used as control groups.

Results

Median preoperative HSA was 7.9 cm², (interquartile IQR 5.97–9.80) while intraoperative median HSA was 6 cm² (6–9.5), p = .84. Postoperative median HSA was 3.8 cm² (3.21–4.8), showing the efficacy of cruroplasty, comparable with HSA calculated in the control groups (3.98 for B and 3.69 cm² for C, p = .8547). No statistically significant difference between MDCT preoperative measurement and intraoperative findings was observed.

Conclusions

Preliminary results demonstrate MDCT scan HSA measurements as a valid, non-invasive method to predict intraoperative findings. It allows the HSA monitoring in order to correlate the symptoms onset and failure of cruroplasty.

Keywords:

• Hiatal surface area HSA
• hiatal hernia
• bariatric surgery
• MDCT scan
• posterior cruroplasty

Acknowledgements

We thank Prof. Alessandro Fonda, from University of Studies of Trieste, Italy, for assisting us with the mathematically demonstration of non-significant errors using the simplified formula during the intraoperative measurement of HSA.

The preliminary results of our study were presented as oral presentations at the National Congress of SICE (Italian Society of Endoscopic Surgery) in Milan, Italy 2017 and at the 22th World Congress of IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) in London, UK 2017.

The work described has not been published before; it is not under consideration for publication anywhere else. The publication has been approved by all co-authors, as well as by the responsible authorities at the institute where the work has been carried out. The publisher will not be held legally responsible should there be any claims for compensation.

Ethical approval

No ethical approval was required for this study. Permission was granted by the Institutional Review Board for this retrospective study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent was not required. Informed consent was obtained from all individual participants included in the study.

This article does not contain any studies with animals performed by any of the authors.

Author contributions

All individual-participant data collected during this study will be available to access, after de-identification. Data and documents, including the study protocol, statistical analysis plan, technical details (like CT algorithm) and informed consent forms (in Italian) will be available. Data will only be available for use in individual participant data meta-analyses, and access will be provided to researchers after a proposal has been approved by an independent review committee identified for this purpose. Data will be available beginning at three months and ending at 24 months after publication of this article. Proposals should be directed to [email protected]; to gain access, data requesters will need to sign a data access agreement, and the de-identified database will be transferred by email.

Declaration of interest

All authors declare that they have no conflicts of interest. No funding was received for this study.