Association of esophageal hiatus size with reflux esophagitis and type I hiatal hernia in patients with obesity.

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.