Background

The decision to repair hiatal hernias during sleeve gastrectomy (SG) is made based on preoperative diagnosis or intraoperative findings. This study aims to compare the outcomes after sleeve gastrectomy with hiatal hernia repair (SG+HHR) based on the timing of HH diagnosis. This IRB-approved study followed patients at a single institution who underwent SG+HHR from 2015 to 2019 over 5 years. Preoperatively diagnosed HH (based on EGD or imaging) were categorized as group A while patients with incidentally found HH at time of surgery were grouped as B. Data was evaluated to differentiate between the two groups based on reoperation rate, antireflux medication use and number of GERD related diagnostic tests performed. 93/110 (84.5%) of patients with SG+HHR had preoperative HH diagnosis while 17/110 (15.5%) had an incidental intraoperative finding of HH. At 5-year follow-up, 9.7% of group A patients had reoperations, 22.6% had EGDs and 28.0% had GERD and HH-related diagnostic tests while group B had 11.8%, 29.4%, and 52.9% respectively. Preoperative vs postoperative antireflux medication use in group A was 31/93 (33.3%) and 67/93 (70.0%) at a mean of 3.3years while group B had 7/17 (41.2%) and 12/17 (70.6%) at a mean of 4.1 years. A comparison of both groups showed no significant difference except for a higher rate of GERD and HH-related diagnostic tests in group B.GERD-related clinical outcomes after SG+HHR are not affected by timing of hiatal hernia diagnosis before or incidentally at surgery, however, the latter tends to have more GERD and HH-related diagnostic testing.