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Published on: December 23, 2022
Preoperative CT-based quantitative assessment of hernial SAC predicts early recurrence following primary hiatal
Takahiro Ochiai1,2, Masanobu Nakajima3, Masatoshi Nakagawa3
1Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsugagun, Tochigi, 321-0293, Japan. t-ochiai213@dokkyomed.ac.jp.
Background:
Recurrence of hiatal hernia after primary repair is a major concern, particularly early recurrence related to technical factors. Reliable preoperative predictors are essential for optimal surgical strategies. Because the hernial sac area can also affect operative complexity, this study aimed to evaluate early recurrence-associated factors and their relationship with operative time using quantitative computed tomography (CT).
Methods:
We retrospectively analyzed 48 patients who underwent laparoscopic hiatal hernia repair between July 2012 and July 2025. Preoperative CT was used to measure the maximum diameter and area of the hernial sac in the axial and coronal planes. We examined the association between these parameters and surgical outcomes including recurrence.
Results:
Early recurrence was observed in four patients (8.3%), all of whom required reoperation within 3 days. Patients with early recurrence had longer operative times and larger axial hernial sac areas (p < 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that the axial maximum diameter provided the highest predictive performance for early recurrence (area under the curve [AUC] = 0.89), with an optimal cutoff value of 117.6 mm. Other parameters, including axial area, coronal area, coronal diameter, and hiatal width, showed moderate predictive ability but none exceeded axial diameter accuracy.
Conclusion:
Axial hernial sac measurements are associated with early recurrence. Preoperative CT-based quantitative assessments may provide valuable information for predicting surgical complexity and recurrence, thereby supporting preoperative risk stratification and surgical planning. Therefore, prospective validation using a larger cohort is warranted.
