Background

Surgeons often encounter and repair hiatal hernias during sleeve gastrectomy (SG) to prevent postoperative reflux, hiatal hernia (HH) reoccurrence and GERD progression. This single institutional study aims to examine the long-term GERD-related outcomes after sleeve gastrectomy with concomitant hiatal hernia repair (SG+HHR). This retrospective study was IRB-approved and included all patients who underwent SG+HHR from 2015 to 2019. Over 5 years, outcomes were monitored for re-operations, imaging, and endoscopic procedures related to GERD and hiatal hernia recurrence. Antireflux medication use was also reviewed.110 patients underwent HHR+SG. Preoperative EGD was available in 90% (99/110) of patients and 80.8% (80/99) had endoscopic evidence of HH. Hill grade was reported in 62.6% (62/99) patients with Hill Grade >= 3 noted in 33.3% (33/99). Mean BMI was 45.9 +- 7.5 (Kg/m2) preoperatively and 34.8 +- 6.8 (Kg/m2) at mean follow-up of 3.9 years. 10% (11/110) of patients had GERD-related reoperations with 45.5% bypass with redo HHR, 36.4% redo HHR, and 18.2% bypass alone. At reoperations, 4/11 patients originally had a Hill grade of >= 3 before their index surgery. Preoperative antireflux medication use was reported in 34.5% of patients and increased to 71.8% postoperatively with 87% of patients who were on preoperative medications continuing use at a mean of 3.4 years.Concomitant hiatal hernia repair at the time of sleeve gastrectomy is durable over at least 3 years. However, many patients continue to need PPI postoperatively with about 10% eventually getting additional operations related to persistent GERD and HH reoccurrence.