Hiatal surface area measurement – a useful tool during laparoscopic antireflux surgery

Abstract

Introduction. Accurate measurement of the esophageal hiatus is essential during laparoscopic repair of hiatal hernia, especially in patients with gastroesophageal reflux disease. Traditional intraoperative assessments are often subjective and inconsistent. This study proposes a novel, objective method for measuring the hiatal surface area using digital photography and open-source image analysis software. Material and methods. Our study included 25 consecutive patients with hiatal hernia and gastroesophageal reflux disease undergoing laparoscopic fundoplication. During surgery, standardized digital photographs of the hiatal defect were captured with a fixed-size benchmark (1.0×1.0 cm). Images were analyzed postoperatively using ImageJ software to determine the hiatal surface area. Preoperative and 12-month postoperative symptom severity was measured using the Gastroesophageal Reflux Disease-Health Related Quality of Life score. Correlations between hiatal surface area, symptoms, and hernia recurrence were evaluated statistically. Results. The mean hiatal surface area was 5.4 ± 1.8 cm². A strong positive correlation was observed between hiatal surface area and preoperative symptoms severity (r = 0.69), as well as postoperative improvement (r = 0.74). At 12 months, 88% of patients achieved significant symptoms reduction (≥50% reduction in Gastroesophageal Reflux Disease-Health Related Quality of Life score). Recurrence of symptoms was noted in 12% of patients, all of whom had a hiatal surface area greater than 6.0 cm². Therefore, patients with a hiatal surface area ≥6.0 cm² showed a higher risk of recurrence and less symptoms improvement compared to those with smaller defects. Conclusions. The proposed intraoperative measurement technique is a simple, cost-effective, and reproducible tool for quantifying hiatal defects. It provides clinically meaningful information that can assist in surgical planning, predict postoperative outcomes, and identify patients who may benefit from reinforced crural repair.