BACKGROUND: Traditional investigations of esophageal hiatal assessment for reflux disease and hiatal hernia (HH), such as endoscopy and barium swallow are subjective. High resolution manometry (HRM) limits hiatal hernia assessment to vertical length. We report a novel use of 3D volumetric Computed Tomography with effervescent oral contrast (Fizz-CT) as a means of preoperative HH diagnosis. METHODS: A pilot series of 12 consecutive patients who underwent preoperative Fizz-CT assessment, as well as a combination of traditional investigations for HH (five primary, seven revisional HH). RESULTS: The median age was 70years (IQR 57.5-76.8years) and median BMI 28.62 kg/m CONCLUSION: Fizz-CT imaging is a novel and accurate means of objective esophageal hiatal assessment in both primary and revisional HH patients. Vertical and radial measures of hiatal defects as well as hernia volumetry can be obtained. In post-surgical patients the relationship between the esophago-gastric junction and an infra- or supra-diaphragmatic fundoplication can also be assessed.