Computed Tomography-Derived Myosteatosis and Diaphragmatic Crus Morphology Are Associated with Radiologically Documented Recurrence Following Sliding Hiatal Hernia Repair: A Retrospective Cohort Study

Background: Systemic muscle composition and local diaphragmatic crus morphology may be associated with recurrence after sliding hiatal hernia repair. This study evaluated the associations of preoperative CT-derived muscle measurements with radiologically documented recurrence after primary type I sliding hiatal hernia repair. Methods: This retrospective single-center study identified 132 patients who underwent repair between January 2015 and July 2024. The primary recurrence analysis was restricted to 48 patients with postoperative CT. Preoperative measurements included L3 skeletal muscle attenuation and diaphragmatic crus thickness and attenuation. Associations were evaluated using between-group comparisons and separate univariable Firth penalized logistic regression models. Multivariable models and analyses involving the overall cohort were retained as exploratory supplementary analyses. Results: Among the 48 CT-imaged patients, 15 had radiologically documented recurrence and 33 had no recurrence detected on available CT. Myosteatosis was more frequent in patients with recurrence (80.0% versus 18.2%; p < 0.001). Mean crus attenuation (31.53 ± 4.69 versus 37.21 ± 3.61 HU) and thickness (5.51 ± 0.61 versus 6.39 ± 0.71 mm) were lower in patients with recurrence (both p < 0.001). In separate univariable models, myosteatosis (OR, 15.11; 95% CI, 3.84–75.00), lower crus attenuation (OR per 1-HU decrease, 1.37; 95% CI, 1.15–1.72), and reduced crus thickness (OR per 1-mm decrease, 8.02; 95% CI, 2.42–44.33) were associated with documented recurrence. These estimates were unadjusted and imprecise. Conclusions: Among selectively CT-imaged patients, myosteatosis and adverse crural muscle measurements were associated with documented recurrence. Limited events, nonstandardized imaging, and uncontrolled confounding preclude definitive prognostic conclusions. Larger studies with standardized postoperative imaging are required.