THE LIFETIME MORPHOMETRY OF CARDIOESOPHAGEAL TRANSITION IN PATIENTS WITH HIATAL HERNIA

With the development of X-ray technology and the advent of computed tomography, it became possible not only to accurately diagnose hiatal hernia, but also to conduct morphometry of all its constituent anatomical structures in different projections to use the data obtained at the stage of preoperative planning for its surgical treatment. Currently, due to the improvement in the quality of diagnostics, there is an increase in the detection of patients with this pathology, along with this, the question of choosing the most rational method of treatment is acute. The aim of the study was to study the computed tomographic anatomy of the structures of the cardioesophageal junction in patients with hiatal hernia. A retrospective study of a series of computed tomograms in 53 patients with hiatal hernia, performed on a 64-slice Canon Aquilion Prime tomograph, was carried out. An assessment was made of the diameter of the distal esophagus, the size of the hernia orifice, and the deviation of the axis of the esophagus at the level of the hernial orifice relative to the diaphragm in two planes. As a result of the analysis, it was found that in 79% of cases the esophagus was located on the right and behind the hernial sac, in 13% - behind and in the middle, in 8% - on the left and behind. It was revealed that the diameter of the unchanged part of the esophagus above the hernial sac was 20.9±3.71 mm (min – 15.7 mm, max – 30.2 mm). The dimensions of the hernial orifice varied within 31.21±5.23 mm in the frontal plane (min - 24.7 mm, max - 42 mm) and 32.66±4.36 mm in the sagittal plane (min - 26.2 mm, max - 39.1 mm). The deviation of the axis of the esophagus in the frontal plane was 63.53°±16.74 (min - 19.6°, max - 92.3°). The deviation of the axis of the esophagus in the sagittal plane was 74.12°±21.31 (min - 36.3°, max - 118.1°). Thus, due to the variability in the structure and location of the anatomical structures of the cardioesophageal zone in patients with hiatal hernia, it is necessary to take into account all of the above indicators, including the presence or absence of large branches of the greater omentum in the hernial sac, body type, gender, age of patients, which serves an integral part of preoperative planning of surgical treatment, optimization and reduction of complications, as well as determining the safest method of its surgery.

1. Akhmatov AM, Tarbaev IS, Vasilevskiy DI. Istoriya razvitiya khirurgii gryzh pishchevodnogo otverstiya diafragmy. Pediatr. 2018;9(3):77-80. In Russian. DOI: 10.17816/PED9377-80

2. Cherkasov DM. Khirurgicheskoe lechenie oslozhnennykh form gryzh pishchevodnogo otverstiya diafragmy. Diss. na soisk. uch. st. dokt. med. nauk. Rostov-na-Donu, 2019.- 248s. In Russian

3. Galimov OV, KHanov VO, Mamadaliev DZ i dr. Kreativnaya khirurgiya gryzhi pishchevodnogo otverstiya diafragmy. Khirurgiya. Zhurnal imeni N.I. Pirogova. 2017;7:30-32. In Russian. DOI: 10.17116/hirurgia2017730-32

4. Hyun JJ, Bak YT. Clinical significance of hiatal hernia. Gut Liver. 2011;5(3):267–277. DOI: 10.5009/gnl.2011.5.3.267

5. Abdullaev BA. Khirurgicheskaya taktika lecheniya gryzh pishchevodnogo otverstiya diafragmy, oslozhnennykh krovotecheniem. Avtoref. diss. na soisk. uch. st. kand. med. nauk.- Moskva, 2008.- 26s. In Russian

6. Grubnik VV, Malinovskiy AV. Oslozhneniya i neudovletvoritel'nye rezul'taty laparoskopicheskoy plastiki gryzh pishchevodnogo otverstiya diafragmy: analiz otdalennykh rezul'tatov i povtornykh operaciy. Kharkіvs'ka khіrurgіchna shkola. 2013;1:106-111. In Russian

7. Grintsov AG, Ishchenko RV, Sovpel' IV i dr. Prichiny neudovletvoritel'nykh rezul'tatov posle laparoskopicheskikh plastik gryzh pishchevodnogo otverstiya diafragmy. Research'n Practical Medicine Journal. 2021;8(1):40-52. In Russian. DOI:10.17709/2409-2231-2021-8-1-4

8. Koch OO, Asche KU, Berger J. Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty. Surg. Endosc. 2011;25:1024–1030. DOI:10.1007/s00464-010-1308-3

9. Cherkasov DM, Cherkasov MF, Tat'yanchenko VK i dr. Differentsirovannyy podkhod k vyboru plastiki gryzh pishchevodnogo otverstiya diafragmy. Endoskopicheskaya khirurgiya. 2020;26(1):5-12. In Russian. DOI: 10.17116/endoskop2020260115

10. Boru CE, Rengo M, Iossa A et al. Hiatal Surface Area's CT scan measurement is useful in hiatal hernia's treatment of bariatric patients, Minimally Invasive Therapy & Allied Technologies. 2021; 30(2):86-93. DOI: 10.1080/13645706.2019.1683033

11. Broucek JR, Ritter LA, Francescatti AB et al. Radiographic Predictability of Hiatal Hernia Prior to Gastric Band Surgery. JSLS: Journal of the Society of Laparoendoscopic Surgeons. (2014);18:243-245. DOI: 10.4293/108680813X13753907291233

12. Rengo M, Bellini D, Iorio O et al. Role of preoperative imaging with multidetector computed tomography in the management of patients with gastroesophageal refux disease symptoms after laparoscopic sleeve gastrectomy. Obes Surg 2013;23:1981–1986. DOI: 10.1007/s11695-013-1003-2

13. Ouyang AM, Hava W, Zhao S et al. In vivo measurement of esophageal hiatus surface area using MDCT: description of the methodology and clinical validation. Abdominal Radiology. 2020;45(4):2656-2662. DOI:10.1007/s00261-019-02279-7

14. Rengo M, Boru CE, Badia S. Preoperative measurement of the hiatal surface with MDCT: impact on surgical planning. La radiologia medica. 2021;126:1508–1517. DOI:10.1007/s11547-021-01413-0

15. Mironchev AO, Kagan II. Komp'yuterno-tomograficheskaya anatomiya abdominal'nogo otdela pishchevoda, gryzh pishchevodnogo otverstiya diafragmy i vozmozhnosti ikh ranney diagnostiki. Operativnaya khirurgiya i klinicheskaya anatomiya. 2021;5(3):30-37. In Russian. DOI: 10.17116/operhirurg2021503130

16. Dronova OB, Kagan II, Tretyakov AA, Mishchenko AN. Diagnostika gastroezofagealnoy reflyuksnoy bolezni.- Orenburg, 2008.- 90s. In Russian

17. Kao AM, Ross SW, Otero J et al. Use of computed tomography volumetric measurements to predict operative techniques in paraesophageal hernia repair. Surg Endosc. 2020;34(4):1785-1794. DOI: 10.1007/s00464-019-06930-8

18. Saad AR, Velanovich V. Anatomic observation of recurrent hiatal hernia: recurrence or disease progression? J Am Coll Surg. 2020;230:999–1007. DOI: 10.1016/j.jamcollsurg.2020.03.011

19. Grishina EE. Kompleksnoe issledovanie rezul'tatov endokhirurgicheskogo lecheniya gastroezofageal'noy reflyuksnoy bolezni: Avtoref. diss. na soisk. uch. st. kand. med. nauk. Ufa, 2016.- 34s. In Russian

20. Shevkunenko VN, Geselevich AM. Tipovaya anatomiya cheloveka. Leningrad: OGIZ, Leningr. otd., 1935.- 232s. In Russian

21. Petrovskiy BV, Kanshin NN, Nikolaev NO. Khirurgiya diafragmy. Leningrad: Meditsina, 1966.- S. 70-96. In Russian

22. Borraez BA, Fisichella PM, Allaix ME et al. Esophageal diseases. Evaluation and treatment. Springer International Publishing Switzerland. 2014;XII:248. DOI: 10.1007/9783319043371_2

23. Hyun JJ, Bak YT. Clinical significance of hiatal hernia. Gut Liver. 2011;5(3):267–277. DOI: 10.5009/gnl.2011.5.3.267

24. Granderath FA. Measurement of the esophageal hiatus by calculation of the hiatal surface area (HSA). Why, when and how? Surg. Endosc. 2007;21:2224–2225. DOI: 10.1007/s00464-007-9348-z

25. Kulagin AL, Afanas'eva NI, Yudin AL, Yumatova EA. Vozmozhnosti komp'yuternoy tomografii v diagnostike gryzhi pishchevodnogo otverstiya diafragmy. Luchevaya diagnostika i terapiya. 2016;(3):15-24. In Russian. DOI: 10.22328/2079-5343-2016-3-15-24

26. Bibikova AA. Strukturno-funktsional'naya organizatsiya i vozrastnye izmeneniya diafragmal'no-pishchevodnogo kompleksa. Avtoref. diss. na soisk. uch. st. kand. med. nauk.- Tver', 2011.- 125s. In Russian