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. 2025 Apr 3:12:1513695.
doi: 10.3389/fsurg.2025.1513695. eCollection 2025.

Comparing the clinical outcomes of laparoscopic sleeve gastrectomy and hiatal hernia repair with or without fundoplication for weight loss and gastrointestinal reflux resolution

Hussam Al Trabulsi  1 , Dunia Al Trabulsi  2 , Khadeja Alrefaie  3 , Tala Muassess  1 , Salman Yousuf Guraya  4
Affiliations

Comparing the clinical outcomes of laparoscopic sleeve gastrectomy and hiatal hernia repair with or without fundoplication for weight loss and gastrointestinal reflux resolution

Hussam Al Trabulsi et al. Front Surg. .

Abstract

Introduction: Evidence suggests that hiatal hernia should be repaired if found during laparoscopic sleeve gastrectomy (LSG), either to prevent new-onset post-operative gastro-esophageal reflux disease (GERD), or to treat pre-existing reflux symptoms. There is interest in performing laparoscopic Nissen's fundoplication (LNF) along with hiatal hernia repair (HHR) during LSG. This study aimed to determine whether hiatal crural repair alone is adequate for symptomatic control. We compared operative time, body mass index (BMI), and reflux symptoms between those undergoing LSG with HHR vs. LSG with HHR and LNF.

Materials and methods: We retrospectively analyzed clinical data of patients who underwent LSG with HHR. This cohort was divided into those with LNF (group 1) and without LNF (group 2). We collected patients' pre-operative BMI and GERD Questionnaire (GERD-Q) scores. We then compared pre-operative BMI and GERD-Q values with post-operative indices at 1-month, 3-months, and 6-months. The patients' medical records for operative findings and time between both groups was analyzed. Statistical analyses included Independent Samples T-tests, Paired T-tests, and correlation analysis.

Results: In this study, 978 bariatric surgeries were performed. Of 431 LSG patients, 73 fulfilled the study criteria. Both groups showed significant reduction in BMI and GERD-Q scores post-operatively. Group 1 had a decrease in BMI from an average pre-operative value of 38.03-32.17 at 6 months (p < 0.001), and GERD-Q scores from 12.25 to 6.47 (p < 0.001). Group 2 showed a BMI decrease from 39.63 to 31.67 (p < 0.001) and GERD-Q scores from 11.54 to 6.93 (p < 0.001) at 6 months. Average operative time was similar in both groups, 76.41 and 79.15 min for group 1 and 2, respectively (p = 0.621).

Conclusion: Our research with short-term results reports similar improvement in BMI and GERD symptoms in patients with LSG and HHR with or without LNF. A sound repair of hiatal crura combined with LSG leads to comparable outcomes to crural repair combined with LNF and LSG for weight loss and reflux resolution. Our short-term results do not support LNF in combination with LSG and HHR. Further research is essential to determine the long-term outcomes.

Keywords: GERD; Nissen fundoplication; hiatal hernia repair; laparoscopic sleeve gastrectomy; obesity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Hiatal hernia defect clearly visible after surgical dissection.
Figure 2
Figure 2
Repair of hernial defect using Ethibond sutures with a figure-of-eight technique.
Figure 3
Figure 3
Laparoscopic Nissen fundoplication with a fundal wrap around lower esophagus.
Figure 4
Figure 4
Key steps of laparoscopic sleeve gastrectomy. (A) Sleeving of the stomach, starting approx. 4 cm away from the pylorus. (B) Sleeving of the stomach continued upwards sparing the fundoplication. (C) A surgical view of gastric sleeve with the hiatal hernia repair and fundoplication. (D) Oversewing the staple line after the creation of the gastric sleeve. (E) A final surgical view after oversewing the staple line and fixing the sleeved stomach to the omentum.
Figure 5
Figure 5
A heatmap analysis for the correlation dynamics in postoperative outcomes.
See this image and copyright information in PMC

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