Diagnostic features of hiatal hernia: a retrospective cohort study

Background. Accurate preoperative diagnosis of hiatal hernia dimensions is critically important for surgical planning, as underestimation of hernia parameters may lead to inadequate selection of surgical techniques and increased risk of recurrence. Development of an effective diagnostic algorithm using modern imaging methods contributes to improved quality of surgical treatment and reduced frequency of adverse outcomes.

Aims. To evaluate the diagnostic accuracy of various imaging methods for hiatal hernia and determine the optimal preoperative examination algorithm to improve surgical treatment outcomes.

Materials and methods. This retrospective cohort study included 81 patients with hiatal hernia (51 women, 30 men; mean age 44.5 ± 12.3 years) who underwent laparoscopic treatment between January 2019 and December 2024. All patients underwent esophagogastroduodenoscopy (EGD). When discrepancies were identified between the clinical presentation and endoscopic measurements, additional diagnostic imaging was performed: contrast radiography (n = 49, 60.5 %), multislice computed tomography (MSCT, n = 29, 35.8 %), and contrast-enhanced MSCT (n = 14, 17.3 %). Hiatal hernia dimensions were determined preoperatively and intraoperatively, followed by statistical analysis of diagnostic accuracy.

Results. Preoperative hiatal hernia dimensions were distributed as follows: ≤ 35 mm – 46 patients (56.8 %), 35–50 mm – 26 patients (32.1 %), > 50 mm – 9 patients (11.1 %). In 59 patients (72.8 %), intraoperative dimensions exceeded preoperative EGD estimates by an average of 8.4 ± 3.1 mm. The greatest discrepancies were observed in hernias >50 mm (13.8 ±4.2 mm). Contrast-enhanced MSCT demonstrated the highest diagnostic accuracy: sensitivity 95.1 %, specificity 90.2 %, surpassing EGD (91.8 % and 75.4 %) and contrast radiography (86.7 % and 82.1 %). During 6–36 months follow-up, complete symptom resolution was achieved in 84.2 % of patients, with recurrence rate of 3.9 %.

Conclusions. A differentiated approach to hiatal hernia diagnosis using MSCT as the method of choice ensures high accuracy of preoperative planning and improves treatment outcomes.

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