Qi Zhong, Shi Xiao-Chen, Yan Wen-Mao, Bai Ri-Xing
Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
World J Radiol. 2025 May 28;17(5):106333. doi: 10.4329/wjr.v17.i5.106333.
Chinese surgeons often rely on intraoperative exploration of the esophageal hiatus to determine the need for concurrent type I hiatal hernia (HH) repair during laparoscopic sleeve gastrectomy. However, no standardized criteria for the esophageal hiatus size or indications for exploration exist in China.
To investigate normal anatomical parameter ranges of the esophageal hiatus in patients with obesity.
A total of 158 patients, aged 20-49 years, was analyzed from January 2020 to June 2024. The patients were classified into the no reflux esophagitis (RE) no HH group (HHG), RE group, and type I HHG. The transverse and sagittal diameters and cross-sectional area of the esophageal hiatus were measured using multiplanar reconstruction of the computed tomography images.
Body mass index was positively correlated with area and transverse and sagittal diameters of the esophageal hiatus ( = 0.72, 0.69, and 0.54, respectively; < 0.01). In the no RE no HHG and RE group, the esophageal hiatus size in the subgroup with obesity was greater than that in the non-obesity subgroup (area: 326.15 ± 78 mm 208.12 ± 64.44 mm, transverse diameters: 15.97 ± 2.06 mm 13.37 ± 1.99 mm, sagittal diameters: 15.7 ± 2.08 mm 11.73 ± 2.08 mm; < 0.01). Patients with obesity showed no significant differences in esophageal hiatus size with or without RE or HH.
The esophageal hiatus size increased with body mass index and was larger in patients with obesity than in those without obesity.
中国外科医生在腹腔镜袖状胃切除术期间，常依靠术中对食管裂孔的探查来确定是否需要同时进行Ⅰ型食管裂孔疝（HH）修复。然而，中国尚无关于食管裂孔大小的标准化标准或探查指征。
探讨肥胖患者食管裂孔的正常解剖参数范围。
分析2020年1月至2024年6月期间的158例年龄在20 - 49岁的患者。将患者分为无反流性食管炎（RE）无HH组（HHG）、RE组和Ⅰ型HHG组。使用计算机断层扫描图像的多平面重建测量食管裂孔的横径、矢状径和横截面积。
体重指数与食管裂孔的面积、横径和矢状径呈正相关（分别为r = 0.72、0.69和0.54；P < 0.01）。在无RE无HHG组和RE组中，肥胖亚组的食管裂孔大小大于非肥胖亚组（面积：326.15±78mm²对208.12±64.44mm²，横径：15.97±2.06mm对13.37±1.99mm，矢状径：15.7±2.08mm对11.73±2.08mm；P < 0.01）。肥胖患者无论有无RE或HH，食管裂孔大小均无显著差异。
食管裂孔大小随体重指数增加而增大，肥胖患者的食管裂孔大于非肥胖患者。
