Abstract:
Introduction. Accurate measurement of the esophageal hiatus is essential during laparoscopic repair of hiatal hernia, especially
in patients with gastroesophageal reflux disease. Traditional intraoperative assessments are often subjective and
inconsistent. This study proposes a novel, objective method for measuring the hiatal surface area using digital photography
and open-source image analysis software.
Material and methods. Our study included 25 consecutive patients with hiatal hernia and gastroesophageal reflux disease
undergoing laparoscopic fundoplication. During surgery, standardized digital photographs of the hiatal defect were
captured with a fixed-size benchmark (1.0×1.0 cm). Images were analyzed postoperatively using ImageJ software to determine
the hiatal surface area. Preoperative and 12-month postoperative symptom severity was measured using the Gastroesophageal
Reflux Disease-Health Related Quality of Life score. Correlations between hiatal surface area, symptoms, and
hernia recurrence were evaluated statistically.
Results. The mean hiatal surface area was 5.4 ± 1.8 cm². A strong positive correlation was observed between hiatal surface
area and preoperative symptoms severity (r = 0.69), as well as postoperative improvement (r = 0.74). At 12 months, 88%
of patients achieved significant symptoms reduction (≥50% reduction in Gastroesophageal Reflux Disease-Health Related
Quality of Life score). Recurrence of symptoms was noted in 12% of patients, all of whom had a hiatal surface area greater
than 6.0 cm². Therefore, patients with a hiatal surface area ≥6.0 cm² showed a higher risk of recurrence and less symptoms
improvement compared to those with smaller defects.
Conclusions. The proposed intraoperative measurement technique is a simple, cost-effective, and reproducible tool for
quantifying hiatal defects. It provides clinically meaningful information that can assist in surgical planning, predict postoperative
outcomes, and identify patients who may benefit from reinforced crural repair.
