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

Background: 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. Objective: To evaluate the effect of concomitant hiatal hernia repair (HHR) during LSG on postoperative GERD symptoms. Methods: 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. Results: 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. Conclusion: 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.