Short-Term outcomes of Concomitant Hiatal Hernia Repair during Laparoscopic Sleeve Gastrectomy on Gastroesophageal Reflux Disease in morbidly obese patients

Abstract

Obesity is strongly associated with an increased risk of hiatal hernia (HH) and gastroesophageal reflux disease (GERD). The impact of laparoscopic sleeve gastrectomy (LSG) on GERD remains controversial. To evaluate the effect of concomitant hiatal hernia repair (HHR) during LSG on postoperative GERD symptoms. A retrospective study was conducted on 106 morbidly obese patients who underwent LSG between March 2021 and December 2024. Patients were divided into two groups: LSG with HHR (Group A, n=45) and LSG alone (Group B, n=61). GERD symptoms were assessed pre- and postoperatively using a standardized questionnaire over a follow-up period of at least one year. All procedures were completed laparoscopically without conversion. Operative time was significantly longer in Group A (83.22 ± 13.18 min vs 51.8 ± 10.13 min, p < 0.001). GERD improvement was significantly higher in Group A (90.4%) compared to Group B ( p =0.04). De novo GERD occurred in 7% of patients in Group A versus 20.4% in Group B (not statistically significant). No significant differences were observed in weight loss outcomes or postoperative complications. Concomitant HHR during LSG is a safe and effective approach that not only significantly improves GERD symptoms but also reduces the incidence of de-novo reflux.