Abstract：
BACKGROUND: Diaphragmatic reconstruction is a vital, but challenging component of hiatal hernia and antireflux surgery. Results are optimized by minimizing axial tension along the esophagus, assessed with intra-abdominal length, and radial tension across the hiatus, which has not been standardized. We categorized hiatal openings into 4 shapes, as a surrogate for radial tension, to correlate their association with operative interventions and recurrence.
METHODS: We retrospectively reviewed all primary hiatal hernias (≥3 cm) repaired at a single center between 2010 and 2020. Patients with intraoperative hiatal photos with at least 1 year of follow-up were included. The hiatal openings were classified into 4 shapes: slit, inverted teardrop, \"D,\" and oval, and ordered in this manner of hypothesized increased complexity and tension.
RESULTS: A total of 239 patients were studied, with 113 (47%) having a recurrence. Age (P < .001), proportion of paraesophageal hernias (P < .001), hernia axial length (P < .001), and hiatal width (P < .001) all increased as shape progressed from slit to inverted teardrop to \"D\" to oval. Mesh (P = .003) and relaxing incisions (P < .001) were more commonly employed in more advanced shapes, \"D\" and ovals. However, recurrence (P = .88) did not correlate with hiatal shape.
CONCLUSIONS: Four different hiatal shapes are commonly seen during hernia repair. These shapes represent a spectrum of hernia chronicity and complexity necessitating increased use of operative measures but not correlating with recurrence. Despite failing to be a direct marker for recurrence risk, hiatal shape may serve as an intraoperative tool to inform surgeons of the potential need for additional hiatal interventions.
METHODS: We retrospectively reviewed all primary hiatal hernias (≥3 cm) repaired at a single center between 2010 and 2020. Patients with intraoperative hiatal photos with at least 1 year of follow-up were included. The hiatal openings were classified into 4 shapes: slit, inverted teardrop, \"D,\" and oval, and ordered in this manner of hypothesized increased complexity and tension.
RESULTS: A total of 239 patients were studied, with 113 (47%) having a recurrence. Age (P < .001), proportion of paraesophageal hernias (P < .001), hernia axial length (P < .001), and hiatal width (P < .001) all increased as shape progressed from slit to inverted teardrop to \"D\" to oval. Mesh (P = .003) and relaxing incisions (P < .001) were more commonly employed in more advanced shapes, \"D\" and ovals. However, recurrence (P = .88) did not correlate with hiatal shape.
CONCLUSIONS: Four different hiatal shapes are commonly seen during hernia repair. These shapes represent a spectrum of hernia chronicity and complexity necessitating increased use of operative measures but not correlating with recurrence. Despite failing to be a direct marker for recurrence risk, hiatal shape may serve as an intraoperative tool to inform surgeons of the potential need for additional hiatal interventions.
摘要：
背景：膈肌重建是至关重要的，但具有挑战性的食管裂孔疝和抗反流手术的组成部分。通过最小化沿食道的轴向张力来优化结果，用腹内长度评估，和穿过裂口的径向张力，这还没有标准化。我们将食管开口分为四种形状，作为径向张力的替代品，将它们与手术干预和复发相关联。
方法：我们回顾性回顾了2010-2020年间在单中心修复的所有原发性食管裂孔疝（≥3cm）。包括具有至少一年随访的术中食管裂孔照片的患者。裂孔分为四种形状：狭缝，倒泪珠,\"D\",和椭圆形，并以这种假设增加的复杂性和张力的方式有序。
结果：共研究了239例患者，113（47%）有复发。年龄（p<0.001），食管旁疝的比例（p<0.001），疝轴向长度（p<0.001），随着形状从狭缝到倒泪滴到“D”到椭圆形，裂孔宽度（p<0.001）都增加了。网格（p=0.003）和松弛切口（p<0.001）更常用于更高级的形状，“D”和椭圆形。然而,复发(p=0.88)与食管形态无关.
结论：在疝修补术中常见四种不同的食管形态。这些形状代表了一系列的疝慢性和复杂性，需要增加手术措施的使用，但与复发无关。虽然不能成为复发风险的直接标志，裂孔形状可以作为术中工具,告知外科医生可能需要额外的裂孔干预措施.
方法：我们回顾性回顾了2010-2020年间在单中心修复的所有原发性食管裂孔疝（≥3cm）。包括具有至少一年随访的术中食管裂孔照片的患者。裂孔分为四种形状：狭缝，倒泪珠,\"D\",和椭圆形，并以这种假设增加的复杂性和张力的方式有序。
结果：共研究了239例患者，113（47%）有复发。年龄（p<0.001），食管旁疝的比例（p<0.001），疝轴向长度（p<0.001），随着形状从狭缝到倒泪滴到“D”到椭圆形，裂孔宽度（p<0.001）都增加了。网格（p=0.003）和松弛切口（p<0.001）更常用于更高级的形状，“D”和椭圆形。然而,复发(p=0.88)与食管形态无关.
结论：在疝修补术中常见四种不同的食管形态。这些形状代表了一系列的疝慢性和复杂性，需要增加手术措施的使用，但与复发无关。虽然不能成为复发风险的直接标志，裂孔形状可以作为术中工具,告知外科医生可能需要额外的裂孔干预措施.
