Is Posoperative Hiatal Hernia an Issue After Slevee Gastrectomy?
In brief
New hiatal hernias tripled esophagitis odds after sleeve gastrectomy
In 329 patients followed with endoscopy, 14% developed a new hiatal hernia after sleeve gastrectomy. Those patients had about three times the adjusted odds of esophagitis, but the link with reflux symptoms was not statistically significant after adjustment. The retrospective findings support endoscopic follow-up, but do not establish that hernias cause esophagitis.
- Journal
- Obesity surgery (Q1)
- Published
- 5 November 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Sofía Ramírez, Nicolas Zoela, Ramiro Leandro Veliz, Franco Jose Signorini, Veronica Gorodner, Federico Moser, et al.
- PMID
- 42986590
- DOI
- 10.1007/s11695-026-09000-w
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (top studies of the week, 8 November 2026): Sleeve-associated hiatal hernia, esophagitis, and reflux follow-up
Abstract
INTRODUCTION: De novo hiatal hernia (HH) after laparoscopic sleeve gastrectomy (LSG) is an increasingly recognized, though likely underestimated, complication, with a reported potential association with esophagitis and gastroesophageal reflux disease (GERD)- related symptoms. OBJECTIVE: To determine the incidence of de novo HH one year after LSG and its independent association with esophagitis and GERD- related symptoms. MATERIALS AND METHODS: A retrospective analysis of prospectively acquired data was conducted in patients who underwent LSG, with systematic pre- and postoperative upper endoscopy. Univariate comparisons were performed using chi-square and Student's t-test. Multivariable binary logistic regression models were used to assess the independent association between de novo HH and postoperative esophagitis and GERD- related symptoms, adjusting for preoperative esophagitis, preoperative GERD-related symptoms, age, BMI, weight loss, and sex. RESULTS: De novo HH incidence was 14.3% (47/329). De novo esophagitis occurred in 16.7% of patients without preoperative esophagitis (51/306), more frequently in HH+ than HH- patients (32.6% vs. 14.1%; p=0.003). On multivariable analysis, de novo HH was independently associated with postoperative esophagitis (OR 3.22; 95% CI 1.58-6.55; p=0.001). GERD-related symptoms were reported in 41.3% overall, with a higher unadjusted rate of de novo symptoms in HH+ patients (30% vs. 16.1%; p=0.072); however, this association did not reach statistical significance after multivariable adjustment (OR 1.72; 95% CI 0.80-3.69; p=0.167). HH size had no significant impact on either outcome. CONCLUSION: De novo HH was independently associated with a higher risk of postoperative esophagitis, whereas its association with GERD-related symptoms did not remain significant after adjustment for confounders. These findings support the role of HH as a risk factor for esophageal mucosal injury and underscore the importance of systematic endoscopic surveillance after LSG.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.