Background

This retrospective study investigated the long-term outcomes of repairing small hiatal hernias (<=2cm) at the time of index sleeve gastrectomy, comparing them to outcomes for larger hernias. Methods:A total of 110 patients who underwent hiatal hernia repair and sleeve gastrectomy were analyzed over a five-year follow-up period. Group A included patients with small hiatal hernias, while Group B comprised those with larger hernias.Results:Results showed that 80.8% of patients had a hiatal hernia preoperatively. At the 5-year follow-up, 19% of Group A and 31% of Group B required subsequent interventions. However, 25% in Group A continued antiacid medications, with 28% experiencing persistent reflux symptoms of which 46% had reflux symptoms prior. In Group B, 19% continued antiacid medications, and 12% had reflux symptoms, all of whom had symptoms prior to surgery.Conclusion:In our 5-year study, repairing small hiatal hernias during the index operation demonstrated favorable long-term outcomes. Group A had lower subsequent intervention rates compared to Group B, yet over 50% in the small hernia group benefited from sleeve with hiatal hernia repair with prior symptoms. Conversely, 100% of symptomatic patients with larger hernias continued to experience symptoms. Addressing small hiatal hernias during sleeve gastrectomy, especially in symptomatic patients, may improve outcomes, potentially reducing reoperation needs and ongoing medical management. Larger hernias may not show similar benefits and could potentially benefit from gastric bypass. Further prospective studies are needed to validate these findings and establish standardized guidelines for hiatal hernia repair in bariatric surgery.