Case Control Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. May 28, 2025; 17(5): 106333
Published online May 28, 2025. doi: 10.4329/wjr.v17.i5.106333
Association of esophageal hiatus size with reflux esophagitis and type I hiatal hernia in patients with obesity
Zhong Qi, Xiao-Chen Shi, Wen-Mao Yan, Ri-Xing Bai
Zhong Qi, Xiao-Chen Shi, Wen-Mao Yan, Ri-Xing Bai, Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Author contributions: Qi Z and Bai RX designed the study; Qi Z, Shi XC, and Yan WM contributed to acquisition and analysis and interpretation of the data; Qi Z wrote the original draft; Yan WM and Bai RX participated in the review and editing; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University.
Informed consent statement: Signed informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ri-Xing Bai, DM, PhD, Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China. brx5168@163.com
Received: February 24, 2025
Revised: April 9, 2025
Accepted: May 10, 2025
Published online: May 28, 2025
Processing time: 92 Days and 23.9 Hours
Abstract
BACKGROUND

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.

AIM

To investigate normal anatomical parameter ranges of the esophageal hiatus in patients with obesity.

METHODS

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.

RESULTS

Body mass index was positively correlated with area and transverse and sagittal diameters of the esophageal hiatus (r = 0.72, 0.69, and 0.54, respectively; P < 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 mm2 vs 208.12 ± 64.44 mm2, transverse diameters: 15.97 ± 2.06 mm vs 13.37 ± 1.99 mm, sagittal diameters: 15.7 ± 2.08 mm vs 11.73 ± 2.08 mm; P < 0.01). Patients with obesity showed no significant differences in esophageal hiatus size with or without RE or HH.

CONCLUSION

The esophageal hiatus size increased with body mass index and was larger in patients with obesity than in those without obesity.

Keywords: Obesity; Esophageal hiatus; Reflux esophagitis; Hiatal hernia; Laparoscopic sleeve gastrectomy

Core Tip: Given the lack of standardized criteria for esophageal hiatus size in patients with obesity, this retrospective case-control study found that esophageal hiatus size increased with body mass index and was larger in patients with obesity than without obesity. The esophageal hiatus area and transverse and sagittal diameters were 326.15 ± 78 mm2, 15.97 ± 2.06 mm, and 15.7 ± 2.08 mm, respectively. Patients with obesity with mild reflux esophagitis or type I hiatal hernia did not exhibit an enlarged esophageal hiatus. Thus, further computed tomography measurements of the esophageal hiatus could provide support for determining the need for intraoperative exploration.