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Surgical Endoscopy

Published in:

01-05-2010

The esophageal hiatus: what is the normal size?

Authors: A. Shamiyeh, K. Szabo, F. A. Granderath, G. Syré, W. Wayand, J. Zehetner

Published in: Surgical Endoscopy | Issue 5/2010

Abstract

Background

A hiatal hernia is defined as the protrusion of intra-abdominal organs through a dilated esophageal hiatus. The esophageal hiatus and its function have been described extensively, but an exact anatomical determination of its normal size is lacking. It seems important to define the normal size, as crural closure is an important part of surgical treatment of gastroesophageal reflux disease (GERD) and hiatal or paraesophageal hernias. The aim of this study was to determine normal values for the size of the esophageal hiatus.

Methods

In a prospective study 50 consecutive cadaver autopsies were performed between February and May 2008. The subjects had died from several diseases not related to GERD. Size of the esophageal hiatus was measured after opening the abdominal cavity before extirpation of any organs. Distance of the cardia and gastroesophageal junction and position of the angle of His were further measured. A formula was used to calculate the hiatal surface area (HSA). Results were analyzed regarding subject height, weight, body mass index (BMI), and chest circumference.

Results

In all 50 cadavers (24 male/26 female) the autopsy was performed and all measurements were obtained. Mean age was 74 years (40–90 years), mean height was 1.68 m (1.39–1.83 m), mean weight was 71 kg (40–120 kg), and mean body mass index (BMI) was 25 kg/m² (14–40 kg/m²). Mean chest circumference was 101 cm (75–178 range). Mean HSA was 5.84 cm² (3.62–9.56 cm²). In all cadavers the gastroesophageal junction was intraabdominal, the mean distance to the angle of His was 3.6 cm (2.7–4.6 cm), the mean length of the right and left crura was similar at 3.6 cm (2.7–4.6 cm), and the opening segment had a mean length of 2.4 cm (1.7–4.0 cm).

Conclusion

The mean HSA was determined in these normal subjects to be 5.84 cm². It was directly proportional to chest circumference and independent of height, weight, BMI, and gender.

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Title: The esophageal hiatus: what is the normal size?
Authors: A. Shamiyeh
K. Szabo
F. A. Granderath
G. Syré
W. Wayand
J. Zehetner
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 5/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-009-0711-0

At a glance: The STEP trials

Springer Medicine

The esophageal hiatus: what is the normal size?

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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