Abstract
Introduction
The size of a hiatal hernia (HH) is a key determinant of the approach for surgical repair. However, endoscopists will often utilize subjective terms, such as “small,” “medium,” and “large,” without any standardized objective correlations. The aim of this study was to identify HHs described using objective axial length measurements versus subjective size allocations and compare them to their corresponding manometry and barium swallow studies.
Methods and procedures
Retrospective chart reviews were conducted on 93 patients diagnosed endoscopically with HHs between 2017 and 2021 at Newton-Wellesley Hospital. Information was collected regarding their HH subjective size assessment, axial length measurement (cm), manometry results, and barium swallow readings. Linear regression models were used to analyze the correlation between the objective endoscopic axial length measurements and manometry measurements. Ordered logistic regression models were used to correlate the ordinal endoscopic and barium swallow subjective size allocations with the continuous axial length measurements and manometry measurements.
Results
Of the 93 endoscopy reports, 42 included a subjective size estimate, 38 had axial length measurement, and 12 gave both. Of the 34 barium swallow reads, only one gave an objective HH size measurement. Axial length measurements were significantly correlated with the manometry measurements (R2 = 0.0957, p = 0.049). The endoscopic subjective size estimates were also closely related to the manometry measurements (R2 = 0.0543, p = 0.0164). Conversely, the subjective size estimates from barium swallow reads were not significantly correlated with the endoscopic axial length measurements (R2 = 0.0143, p = 0.366), endoscopic subjective size estimates (R2 = 0.0481, p = 0.0986), or the manometry measurements (R2 = 0.0418, p = 0.0738). Mesh placement was significantly correlated to pre-operative endoscopic axial length measurement (p = 0.0001), endoscopic subjective size estimate (p = 0.0301), and barium swallow read (p = 0.0211). However, mesh placement was not significantly correlated with pre-operative manometry measurements (0.2227).
Conclusions
Endoscopic subjective size allocations and objective axial length measurements are associated with pre-operative objective measurements and intra-operative decisions, suggesting both can be used to guide clinical decision making. However, including axial length measurements in endoscopy reports can improve outcomes reporting.
Similar content being viewed by others
References
Chang CG, Thackeray L (2016) Laparoscopic hiatal hernia repair in 221 patients: outcomes and experience. J Soc Laparoendosc Surg. https://doi.org/10.4293/JSLS.2015.00104
Huang X, Chen S, Zhao H, Zeng X, Lian J, Tseng Y, Chen J (2017) Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc 31:1032–1044
Rabach L, Saad AR, Velanovich V (2019) How to choose among fundoplication, magnetic sphincter augmentation or transoral incisionless fundoplication. Curr Opin Gastroenterol 35(4):371–378
Trad KS (2016) Transoral incisionless fundoplication: current status. Curr Opin Gastroenterol 32(4):338
Müller-Stich BP, Holzinger F, Kapp T, Klaiber C (2006) Laparoscopic hiatal hernia repair: long-term outcome with the focus on the influence of mesh reinforcement. Surg Endosc Other Interv Tech 20:380–384
Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z, Mittal SK, Richardson WS, Stefanidis D, Fanelli RD, Guidelines Committee SAGES (2013) Guidelines for the management of hiatal hernia. Surg Endosc 27:4409–4428
Frantzides CT, Carlson MA, Loizides S, Papafili A, Luu M, Roberts J, Zeni T, Frantzides A (2010) Hiatal hernia repair with mesh: a survey of SAGES members. Surg Endosc 24(5):1017–1024
Jones R, Simorov A, Lomelin D, Tadaki C, Oleynikov D (2015) Long-term outcomes of radiologic recurrence after paraesophageal hernia repair with mesh. Surg Endosc 29(2):425–430
Antoniou SA, Koch OO, Antoniou GA, Pointner R, Granderath FA (2012) Mesh-reinforced hiatal hernia repair: a review on the effect on postoperative dysphagia and recurrence. Langenbecks Arch Surg 397(1):19–27
Beg S, Ragunath K, Wyman A et al (2017) Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 66:1886–1899
Hansdotter I et al (2016) Hill classification is superior to the axial length of a hiatal hernia for assessment of the mechanical anti-reflux barrier at the gastroesophageal junction. Endosc Int Open 4(3):E311–E317
Wallner B et al (2018) Identifying clinically relevant sliding hiatal hernias: a population-based endoscopy study. Scand J Gastroenterol 53(6):657–660
Hyun JJ, Bak YT (2011) Clinical significance of hiatal hernia. Gut Liver 5(3):267–277. https://doi.org/10.5009/gnl.2011.5.3.267
Ghaferi AA, Schwartz TA, Pawlik TM (2021) STROBE reporting guidelines for observational studies. JAMA Surg 156(6):577–578
Witteman BP et al (2012) Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease in clinical practice. Surg Endosc 26:3307–3315
Koch OO et al (2011) Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty. Surg Endosc 25:1024–1030
Armijo PR et al (2019) Predictors of hiatal hernia recurrence after laparoscopic anti-reflux surgery with hiatal hernia repair: a prospective database analysis. J Gastrointest Surg 23:696–701
Tolone S, Savarino E, Zaninotto G, Gyawali CP, Frazzoni M, de Bortoli N, Frazzoni L, Del Genio G, Bodini G, Furnari M, Savarino V, Docimo L (2018) High-resolution manometry is superior to endoscopy and radiology in assessing and grading sliding hiatal hernia: a comparison with surgical in vivo evaluation. United Eur Gastroenterol J 6(7):981–989
Weijenborg PW, van Hoeij FB, Smout AJ, Bredenoord AJ (2015) Accuracy of hiatal hernia detection with esophageal high-resolution manometry. Neurogastroenterol Motil 27(2):293–299
Kahrilas PJ, Kim HC, Pandolfino JE (2008) Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol 22(4):601–616
Wang P et al (2019) Same-day vs different-day elective upper and lower endoscopic procedures by setting. JAMA Intern Med 179(7):953–963
Acknowledgements
We would like to acknowledge all the gastroenterologists at Newton-Wellesley Hospital for their support of this investigation and dedication to patient care.
Funding
There were no funding sources used in the development of this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Deanna L. Palenzuela, Denise Gee, Charudutt Paranjape, Emil Petrusa, Alexandra Maltby, and Sarah Andrus have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Palenzuela, D.L., Gee, D., Petrusa, E. et al. Hiatal hernia reporting: time to remove subjectivity?. Surg Endosc 38, 437–442 (2024). https://doi.org/10.1007/s00464-023-10562-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-023-10562-4