CT oesophageal hiatal surface area measurements: An objective and sensitive means of hiatal hernia detection

•A retrospective analysis of 287 consecutive patients (2005–2016) who underwent laparoscopic hiatal hernia (HH) repair. Preoperative investigations and CT hiatal surface area (HSA) measurements were evaluated.•Overall, sensitivity for preoperative HH detection was 75.3% (n = 259) for endoscopy, 77.4% (n = 106) for barium swallow, 70.9% (n = 110) for HRM and 80.4% (n = 56) for standard CT reporting. Preoperative sensitivity for CT HSA was 94.6% (n = 37).•Mean CT HSA was significantly higher in the HH group compared to a 1:1 matched control group (8.7cm2 vs 2.2cm2, p < 0.01).•The accuracy of independent radiologist and surgeon observers was the same at 94.6%, with an intra-class correlation coefficient of 1.00 (p < 0.01) demonstrating excellent reliability.