Combining sleeve gastrectomy with hiatal hernia repair holds up well over time, but postoperative acid reflux is a key warning sign. A retrospective study of 108 patients found a 13% hernia recurrence rate over a median 7.5-year follow-up, with GERD and large hernias being the strongest predictors. Notably, reflux symptoms drove more reoperations than anatomical recurrence alone.
A new retrospective study out of Italy offers some of the longest follow-up data yet on laparoscopic sleeve gastrectomy (LSG) combined with hiatal hernia repair — and the results are largely reassuring, with a few important caveats. Researchers tracked 108 patients across four bariatric centers over a median of 90 months (about 7.5 years), finding that the combined procedure delivered acceptable long-term outcomes for most patients.
That said, hernia recurrence did occur in 13% of patients, with freedom from recurrence estimated at 98% at 5 years but dropping to 69% at 10 years. Of those who needed reoperation, more patients went back to the OR for stubborn acid reflux than for an anatomically confirmed hernia recurrence — suggesting that GERD symptoms may be a more clinically meaningful signal of failure than imaging findings alone.
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Why it matters: For bariatric surgeons and gastroenterologists, these findings reinforce that postoperative GERD isn't just a quality-of-life issue — it may be a marker of structural failure. Long-term monitoring of reflux symptoms after LSG with hernia repair could help identify patients who need early intervention before things get worse.
