{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T22:56:43Z","timestamp":1776466603930,"version":"3.51.2"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T00:00:00Z","timestamp":1630022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T00:00:00Z","timestamp":1630022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 degli Studi di Roma La Sapienza"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiol med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To evaluate the accuracy and reproducibility of hiatal surface area (HSA) measurement on dedicated multidetector computed tomography (MDCT) acquisition, in patients, previously subjected to laparoscopic sleeve gastrectomy (LSG), and affected by gastroesophageal reflux disease (GERD). Intraoperative HSA measurement was considered the reference standard.\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Fifty-two candidates for laparoscopic hiatal hernia repair were prospectively included in the study. MDCT images were acquired during swallowing of oral iodinated contrast media and during strain. Measurements were performed by nine readers divided into three groups according to their experience. Results were compared with intraoperative measurements by means of Spearman correlation coefficient. Reproducibility was evaluated with intra- and interreader agreement by means of weighted Cohen\u2019s kappa and intraclass correlation coefficient (ICC).\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Significant differences between MDCT and intraoperative HSA measurements were observed for swallowing imaging for less experienced readers (<jats:italic>p<\/jats:italic>\u2009=\u20090.037, 0.025, 0.028 and 0.019). No other statistically significant differences were observed (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). The correlation between HSA measured intraoperatively and on MDCT was higher for strain imaging compared to swallowing (r\u2009=\u20090.94\u20140.92 vs 0.94\u20140.89). The overall reproducibility of MDCT HSA measurement was excellent (ICC of 0.95; 95% CI 0,8993 to 0,9840) independently of reader\u2019s experience<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>HSA can be accurately measured on MDCT images. This method is reproducible and minimally influenced by reader experience. The preoperative measurement of HSA has potential advantages for surgeons in terms of correct approach to hiatal defects in obese patient.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11547-021-01413-0","type":"journal-article","created":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T13:03:13Z","timestamp":1630069393000},"page":"1508-1517","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Preoperative measurement of the hiatal surface with MDCT: impact on surgical planning"],"prefix":"10.1007","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9087-5692","authenticated-orcid":false,"given":"Marco","family":"Rengo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9171-4460","authenticated-orcid":false,"given":"Cristian E.","family":"Boru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4701-3995","authenticated-orcid":false,"given":"Stefano","family":"Badia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6798-8100","authenticated-orcid":false,"given":"Angelo","family":"Iossa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2731-6959","authenticated-orcid":false,"given":"Davide","family":"Bellini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4970-889X","authenticated-orcid":false,"given":"Simona","family":"Picchia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0967-7101","authenticated-orcid":false,"given":"Nicola","family":"Panvini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3108-7527","authenticated-orcid":false,"given":"Iacopo","family":"Carbone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2356-0505","authenticated-orcid":false,"given":"Gianfranco","family":"Silecchia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3091-7819","authenticated-orcid":false,"given":"Andrea","family":"Laghi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,8,27]]},"reference":[{"key":"1413_CR1","first-page":"s176","volume":"22","author":"CM Apovian","year":"2016","unstructured":"Apovian CM (2016) Obesity: definition, comorbidities, causes, and burden. Am J Manag Care 22:s176\u2013s185","journal-title":"Am J Manag Care"},{"key":"1413_CR2","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1007\/s11695-013-0973-4","volume":"23","author":"M Carabotti","year":"2013","unstructured":"Carabotti M, Silecchia G, Greco F et al (2013) Impact of laparoscopic sleeve gastrectomy on upper gastrointestinal symptoms. Obes Surg 23:1551\u20131557. https:\/\/doi.org\/10.1007\/s11695-013-0973-4","journal-title":"Obes Surg"},{"key":"1413_CR3","doi-asserted-by":"publisher","first-page":"1917","DOI":"10.1007\/s11695-017-2589-6","volume":"27","author":"AA Saber","year":"2017","unstructured":"Saber AA, Shoar S, Khoursheed M (2017) Intra-thoracic sleeve migration (ITSM): an underreported phenomenon after laparoscopic sleeve gastrectomy. Obes Surg 27:1917\u20131923. https:\/\/doi.org\/10.1007\/s11695-017-2589-6","journal-title":"Obes Surg"},{"key":"1413_CR4","doi-asserted-by":"publisher","first-page":"2323","DOI":"10.1007\/s00464-010-1558-0","volume":"25","author":"T Baumann","year":"2011","unstructured":"Baumann T, Grueneberger J, Pache G et al (2011) Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration. Surg Endosc 25:2323\u20132329. https:\/\/doi.org\/10.1007\/s00464-010-1558-0","journal-title":"Surg Endosc"},{"key":"1413_CR5","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1007\/s00464-010-1308-3","volume":"25","author":"OO Koch","year":"2011","unstructured":"Koch OO, Asche KU, Berger J et al (2011) Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty. Surg Endosc 25:1024\u20131030. https:\/\/doi.org\/10.1007\/s00464-010-1308-3","journal-title":"Surg Endosc"},{"key":"1413_CR6","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1007\/s00464-009-0711-0","volume":"24","author":"A Shamiyeh","year":"2010","unstructured":"Shamiyeh A, Szabo K, Granderath FA et al (2010) The esophageal hiatus: what is the normal size? Surg Endosc 24:988\u2013991. https:\/\/doi.org\/10.1007\/s00464-009-0711-0","journal-title":"Surg Endosc"},{"key":"1413_CR7","doi-asserted-by":"publisher","first-page":"3092","DOI":"10.1007\/s11695-017-2748-9","volume":"27","author":"DM Felsenreich","year":"2017","unstructured":"Felsenreich DM, Kefurt R, Schermann M et al (2017) Reflux, sleeve dilation, and Barrett\u2019s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg 27:3092\u20133101. https:\/\/doi.org\/10.1007\/s11695-017-2748-9","journal-title":"Obes Surg"},{"key":"1413_CR8","doi-asserted-by":"publisher","first-page":"3592","DOI":"10.1007\/s00464-018-6087-2","volume":"32","author":"VV Ilyashenko","year":"2018","unstructured":"Ilyashenko VV, Grubnyk VV, Grubnik VV (2018) Laparoscopic management of large hiatal hernia: mesh method with the use of ProGrip mesh versus standard crural repair. Surg Endosc 32:3592\u20133598. https:\/\/doi.org\/10.1007\/s00464-018-6087-2","journal-title":"Surg Endosc"},{"key":"1413_CR9","doi-asserted-by":"publisher","first-page":"3537","DOI":"10.1007\/s10620-016-4331-y","volume":"61","author":"S Akimoto","year":"2016","unstructured":"Akimoto S, Singhal S, Masuda T et al (2016) Esophagogastric junction morphology and distal esophageal acid exposure. Dig Dis Sci 61:3537\u20133544. https:\/\/doi.org\/10.1007\/s10620-016-4331-y","journal-title":"Dig Dis Sci"},{"key":"1413_CR10","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1007\/s13304-018-0562-0","volume":"70","author":"FAM Herbella","year":"2018","unstructured":"Herbella FAM, Schlottmann F, Patti MG (2018) Pathophysiology of gastroesophageal reflux disease: how an antireflux procedure works (or does not work). Updat Surg 70:343\u2013347. https:\/\/doi.org\/10.1007\/s13304-018-0562-0","journal-title":"Updat Surg"},{"key":"1413_CR11","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1007\/s00464-007-9348-z","volume":"21","author":"FA Granderath","year":"2007","unstructured":"Granderath FA (2007) Measurement of the esophageal hiatus by calculation of the hiatal surface area (HSA). Why, when and how? Surg Endosc 21:2224\u20132225. https:\/\/doi.org\/10.1007\/s00464-007-9348-z","journal-title":"Surg Endosc"},{"key":"1413_CR12","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znab094","volume":"108","author":"B H\u00e5kanson","year":"2021","unstructured":"H\u00e5kanson B, Thorell A (2021) Author response to: tension-free mesh versus suture-alone cruroplasty in antireflux surgery: a randomized, double-blind clinical trial. Br J Surg 108:e253. https:\/\/doi.org\/10.1093\/bjs\/znab094","journal-title":"Br J Surg"},{"key":"1413_CR13","doi-asserted-by":"publisher","first-page":"2465","DOI":"10.1007\/s00464-015-4499-9","volume":"30","author":"W Ouyang","year":"2016","unstructured":"Ouyang W, Dass C, Zhao H et al (2016) Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD. Surg Endosc 30:2465\u20132472. https:\/\/doi.org\/10.1007\/s00464-015-4499-9","journal-title":"Surg Endosc"},{"key":"1413_CR14","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1007\/s11605-009-1047-8","volume":"14","author":"HF Batirel","year":"2010","unstructured":"Batirel HF, Uygur-Bayramicli O, Giral A et al (2010) The size of the esophageal hiatus in gastroesophageal reflux pathophysiology: outcome of intraoperative measurements. J Gastrointest Surg 14:38\u201344. https:\/\/doi.org\/10.1007\/s11605-009-1047-8","journal-title":"J Gastrointest Surg"},{"key":"1413_CR15","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.soard.2016.08.006","volume":"13","author":"D Goitein","year":"2017","unstructured":"Goitein D, Sakran N, Rayman S et al (2017) Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy. Surg Obes Relat Dis 13:138\u2013142. https:\/\/doi.org\/10.1016\/j.soard.2016.08.006","journal-title":"Surg Obes Relat Dis"},{"key":"1413_CR16","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1007\/s11695-013-1003-2","volume":"23","author":"M Rengo","year":"2013","unstructured":"Rengo M, Bellini D, Iorio O et al (2013) Role of preoperative imaging with multidetector computed tomography in the management of patients with gastroesophageal reflux disease symptoms after laparoscopic sleeve gastrectomy. Obes Surg 23:1981\u20131986. https:\/\/doi.org\/10.1007\/s11695-013-1003-2","journal-title":"Obes Surg"},{"key":"1413_CR17","first-page":"989","volume":"32","author":"M Bianchetti","year":"2018","unstructured":"Bianchetti M, Peralta S, Nicita R et al (2018) Correlation between the reflux finding score and the GERD impact scale in patients with gastroesophageal reflux disease. J Biol Regul Homeost Agents 32:989\u2013993","journal-title":"J Biol Regul Homeost Agents"},{"key":"1413_CR18","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1097\/MEG.0000000000001914","volume":"33","author":"A Balla","year":"2021","unstructured":"Balla A, Leone G, Ribichini E et al (2021) Gastroesophageal reflux disease \u2013 health-related quality of life questionnaire: prospective development and validation in Italian. Eur J Gastroenterol Hepatol 33:339\u2013345. https:\/\/doi.org\/10.1097\/MEG.0000000000001914","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"1413_CR19","doi-asserted-by":"publisher","DOI":"10.1136\/gut.45.2.172","author":"LR Lundell","year":"1999","unstructured":"Lundell LR, Dent J, Bennett JR et al (1999) Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. https:\/\/doi.org\/10.1136\/gut.45.2.172","journal-title":"Gut"},{"key":"1413_CR20","doi-asserted-by":"publisher","first-page":"2656","DOI":"10.1007\/s00261-019-02279-7","volume":"45","author":"AS Moten","year":"2020","unstructured":"Moten AS, Ouyang W, Hava S et al (2020) In vivo measurement of esophageal hiatus surface area using MDCT: description of the methodology and clinical validation. Abdom Radiol 45:2656\u20132662. https:\/\/doi.org\/10.1007\/s00261-019-02279-7","journal-title":"Abdom Radiol"},{"key":"1413_CR21","doi-asserted-by":"publisher","first-page":"2374","DOI":"10.1007\/s00464-015-4487-0","volume":"30","author":"S Ruscio","year":"2016","unstructured":"Ruscio S, Abdelgawad M, Badiali D et al (2016) Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence. Surg Endosc 30:2374\u20132381. https:\/\/doi.org\/10.1007\/s00464-015-4487-0","journal-title":"Surg Endosc"},{"key":"1413_CR22","doi-asserted-by":"publisher","DOI":"10.1080\/13645706.2019.1683033","author":"CE Boru","year":"2019","unstructured":"Boru CE, Rengo M, Iossa A et al (2019) Hiatal Surface Area\u2019s CT scan measurement is useful in hiatal hernia\u2019s treatment of bariatric patients. Minim Invasive Ther Allied Technol. https:\/\/doi.org\/10.1080\/13645706.2019.1683033","journal-title":"Minim Invasive Ther Allied Technol"},{"key":"1413_CR23","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-006-9041-7","author":"FA Granderath","year":"2007","unstructured":"Granderath FA, Schweiger UM, Pointner R (2007) Laparoscopic antireflux surgery: tailoring the hiatal closure to the size of hiatal surface area. Surg Endosc Other Interv Tech. https:\/\/doi.org\/10.1007\/s00464-006-9041-7","journal-title":"Surg Endosc Other Interv Tech"},{"key":"1413_CR24","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1016\/j.jamcollsurg.2020.03.011","volume":"230","author":"AR Saad","year":"2020","unstructured":"Saad AR, Velanovich V (2020) Anatomic observation of recurrent hiatal hernia: recurrence or disease progression? J Am Coll Surg 230:999\u20131007. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2020.03.011","journal-title":"J Am Coll Surg"}],"container-title":["La radiologia medica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11547-021-01413-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11547-021-01413-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11547-021-01413-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T10:41:08Z","timestamp":1640256068000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11547-021-01413-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,27]]},"references-count":24,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1413"],"URL":"https:\/\/doi.org\/10.1007\/s11547-021-01413-0","relation":{},"ISSN":["0033-8362","1826-6983"],"issn-type":[{"value":"0033-8362","type":"print"},{"value":"1826-6983","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,27]]},"assertion":[{"value":"2 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained by all participants.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}