Background: To determine the clinical relevance of a laparoscopically diagnosed hiatal hernia.
Methods: Consecutive patients undergoing an elective laparoscopy were prospectively recruited. We assessed preoperative gastroesophageal reflux symptoms using a validated score, and documented the presence or absence of a hiatal hernia during laparoscopy.
Results: Of the 95 evaluable patients, 42 (44%) had a hiatal hernia. The mean age was 49.8 years. Logistic regression analysis indicated that three features were significantly and independently associated with hiatal hernia: a higher reflux score (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.48-4.05; p < 0.001), low body mass index (BMI) (OR 0.83; 95% CI 0.70-0.98; p = 0.029), and type of surgery (OR 0.34; 95% CI 0.14-0.92; p = 0.033). The diagnostic accuracy of a reflux score of more than 2 was 81%, with a sensitivity, specificity, positive predictive value, and negative predictive value of 76%, 85%, 80%, and 82%, respectively. The likelihood ratio for a positive result was 5.05.
Conclusion: Hiatal hernia is common in this population of surgical patients undergoing an elective laparoscopy. Patients with reflux symptoms or a low BMI were more likely to have a hiatal hernia. With a reflux score of more than 2, the probability of finding a hiatal hernia during laparoscopy is 80%.