High-resolution 3-dimensional tomography may be a useful tool for understanding the anatomy of hiatal hernias and surgical planning of patients eligible for laparoscopic or robotic antireflux surgery.

BACKGROUND: 3D computed tomography (CT) has been seldom used for the evaluation of hiatal hernias (HH) in surgical patients. This study aims to describe the 3D CT findings in candidates for laparoscopic or robotic antireflux surgery or HH repair and compare them with other tests. METHODS: Thirty patients with HH and/or gastroesophageal reflux disease (GERD) who were candidates for surgical treatment and underwent high-resolution CT were recruited. The variables studied were distance from the esophagogastric junction (EGJ) to the hiatus; total gastric volume and herniated gastric volume, percentage of herniated volume in relation to the total gastric volume; diameters and area of the esophageal hiatus. RESULTS: HH was diagnosed with CT in 21 (70%) patients. There was no correlation between the distance EGJ-hiatus and the herniated gastric volume. There was a statistically significant correlation between the distance from the EGJ to the hiatus and the area of the esophageal hiatus of the diaphragm. There was correlation between tomographic and endoscopic findings for the presence and size of HH. HH was diagnosed with manometry in 9 (50%) patients. There was no correlation between tomographic and manometric findings for the diagnosis of HH and between hiatal area and lower esophageal sphincter basal pressure. There was no correlation between any parameter and DeMeester score. CONCLUSIONS: The anatomy of HH and the hiatus can be well defined by 3D CT. The EGJ-hiatus distance may be equally measured by 3D CT or upper digestive endoscopy. DeMeester score did not correlate with any anatomical parameter.

The Mesenteric Organ: New Anatomical Concepts and an Imaging-based Review on Its Diseases.

The proposal of reclassifying the mesentery as an organ prompts clinicians and radiologists to reappraise their approach to it and to mesenteric diseases (mesenteropathies). Recent updates in mesenteric anatomy and the better comprehension of its structure constitute a basis to push forward the process of disease management and allow the development of less radical (including endoscopic, radiological, and pharmacotherapeutic) treatments. Radiological evaluation currently plays a pivotal role in the noninvasive characterization of abdominal diseases. Mesenteric-based radiological assessments form an essential component in planning radiological interventions and postoperative surveillance programs. The purpose of this article, therefore, is to provide an update on the new anatomical concepts related to the mesentery, also performing an imaging-based review of mesenteric diseases by categorizing them as primary and secondary.