Long-Term Anatomical Durability and Clinical Outcomes of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair: Up to 10-Year Multicenter Analysis

Background Hiatal hernia is common in patients with severe obesity undergoing metabolic bariatric surgery. Although concomitant hiatal hernia repair during laparoscopic sleeve gastrectomy has been widely adopted, long-term data beyond 5 years remain limited, and the clinical relevance of anatomical recurrence is still poorly defined. Objectives To evaluate the 10-year recurrence rate, predictors of failure, and clinical outcomes following concomitant sleeve gastrectomy and hiatal hernia repair. Methods This retrospective multicenter cohort study analyzed 111 patients who underwent sleeve gastrectomy with concomitant hiatal hernia repair between 2014 and 2015. Complete-case analysis included only patients with assessable recurrence status at follow-up. The primary outcome was anatomical recurrence (> 2 cm transhiatal migration of the gastric sleeve). Secondary outcomes included reintervention, gastroesophageal reflux disease (GERD), and weight loss. Results Among 111 patients, 108 were analyzed. Mean age was 50.1 ± 11.6 years, 80.6% female, mean baseline BMI 42.7 ± 5.8 kg/m², and mean follow-up was 93.0 ± 22.7 months (7.7 ± 1.9 years). Hernia recurrence occurred in 14 patients (13.0%). Among these, 5 (35.7%) underwent reintervention, while 9 (64.3%) were managed conservatively. Freedom from recurrence was 98.1% at 5 years and 68.9% at 10 years, although the 10-year estimate should be interpreted cautiously. Hernia size ≥ 5 cm and postoperative GERD were associated with recurrence (OR 5.0; 95% CI 1.2-20.0; P=0.035; OR 4.97; 95% CI 1.56–17.53; p = 0.008). Reintervention was required in 11 patients (10.2%), all with symptomatic GERD. Conclusions Concomitant sleeve gastrectomy and hiatal hernia repair were associated with acceptable long-term outcomes in this multicenter cohort. Reintervention was more often associated with postoperative reflux-related symptoms than with anatomical recurrence alone, while many anatomical recurrences were managed conservatively.