THE ROLE OF 3D MODELING IN THE SURGICAL MANAGEMENT OF HIATAL HERNIAS: A LITERATURE REVIEW

Surgical treatment of hiatal hernia (HH) and concomitant gastroesophageal reflux disease (GERD) remains one of the most complex and controversial areas of modern abdominal surgery. Traditional two-dimensional imaging techniques, such as radiography and conventional computed tomography (CT), are often insufficient for detailed assessment of the complex spatial relationships within the esophagogastric junction. This frequently leads to inaccuracies in preoperative planning and, consequently, to unsatisfactory long-term surgical outcomes. In this context, three-dimensional (3D) modeling based on CT data offers new opportunities for the development of personalized surgical strategies.

To characterize, based on a comprehensive analysis of the literature, the current state, practical applications, and future directions of 3D modeling technologies in the surgical management of hiatal hernia (HH), including the following aspects: diagnosis of the pathology; preoperative planning of the surgical extent and operative strategy; intraoperative navigation; and evaluation of the effectiveness of surgical treatment.

A systematic review was conducted in accordance with the PRISMA guidelines. Publications from 2010 to 2025 were searched and analyzed. The literature search was performed using several scientific databases, including PubMed, Web of Science, Scopus, eLIBRARY, and CyberLeninka. The research methods included analytical review and data synthesis. The inclusion criteria comprised original clinical studies, review articles, and case reports addressing the application of 3D modeling, CT-based anatomical assessment, and virtual and augmented reality technologies in the surgical management of hiatal hernia (HH) and gastroesophageal reflux disease (GERD). Filters were applied to include only studies published in English or Russian and conducted in human subjects. Particular attention was paid to studies reporting clinical effectiveness and practical outcomes associated with the use of these technologies in HH and GERD surgery. The literature search was performed using the following keywords: "reflux esophagitis," "hiatal hernia," "computed tomography," "preoperative planning," "surgical navigation," "3D modeling," and "augmented reality."

The analysis of the obtained data confirms that the implementation of 3D modeling leads to modification of the standard treatment protocol for hiatal hernia (HH). At the diagnostic stage, this technology enables reliable identification of the type and size of the hernia, as well as detailed assessment of anatomical structures that are critical for surgical intervention, including the length of the abdominal esophagus, the degree of separation of the diaphragmatic crura, the presence and extent of esophageal shortening (if present), and specific features of vascular anatomy. These data allow the surgeon to comprehensively evaluate patient-specific anatomical characteristics, determine the optimal surgical approach (laparoscopic, robotic, thoracic, or open), and select the most appropriate type of fundoplication (Chernousov, Nissen, or Toupet technique).

The integration of 3D modeling technologies into routine clinical practice enables comprehensive visualization of anatomical structures, precise measurement of the pathological lesion, and determination of its spatial relationship with adjacent organs and vascular structures. This facilitates accurate planning of the extent and strategy of surgical intervention, minimizes the risk of intraoperative complications, and improves the overall effectiveness of surgical treatment.