Incidence of de Novo Hiatal Hernia after Laparoscopic Sleeve Gastrectomy



After laparoscopic sleeve gastrectomy (LSG), several studies have reported an increase in the incidence of gastroesophageal reflux (GERD). The etiopathogenesis of GERD post-LSG is multifactorial, and hiatal hernia (HH) is one of them.

The primary objective was to measure the incidence of de novo HH post-LSG. The secondary objectives were to relate the presence of HH with GERD, the chronic use of proton pump inhibitors (PPI), and the time elapsed from LSG.

Materials and Methods

A surgical evaluation of the crura after LSG was performed. A retrospective cohort study of 74 consecutive patients with history of LSG submitted to an intra-abdominal surgery that allowed the evaluation of the crura.


Of a total of 74 patients, 51 were included. At the time of surgery, 37 patients (72.5%) had a HH; 24 patients (47.1%) had GERD, and 23 patients (45.1%) were frequently using PPI. When patients with HH and those without HH were compared, GERD was observed in 56.8% versus 21.4% (p = 0.01) and frequent consumption on PPI was found in 54.1% versus 21.4% (p = 0.02). According to the data of LSG, with a follow-up of < 18 months, 60% presented HH; meanwhile, with a follow-up of > 18 months, 84.6% presented HH (p = 0.02).


Patients submitted to LSG showed a high incidence of de novo HH. HH was associated with a higher incidence of GERD and PPI dependence. The longer the time elapsed from the LSG, the greater the incidence of HH.

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  1. 1.

    Khorgami Z, Shoar S, Andalib A, et al. Trends in utilization of bariatric surgery, 2010-2014: sleeve gastrectomy dominates. Surg Obes Relat Dis. 2017;13(5):774–8.

    Article  Google Scholar 

  2. 2.

    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.

    Article  Google Scholar 

  3. 3.

    Himpens J, Dapri G, and Cadie’re GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 2006;16(11):1450–1456.

  4. 4.

    Melissas J, Braghetto I, Molina JC, et al. Gastroesophageal reflux disease and sleeve gastrectomy. Obes Surg. 2015;25(12):2430–5.

    Article  Google Scholar 

  5. 5.

    Laffin M, Chau J, Gill RS, et al. Sleeve gastrectomy and gastroesophageal reflux disease. J Obes. 2013;741097:1–6.

    Article  Google Scholar 

  6. 6.

    Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg. 2010;20(3):357–62.

    Article  Google Scholar 

  7. 7.

    Braghetto I, Csendes A. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg. 2016;26(4):710–4.

    Article  Google Scholar 

  8. 8.

    Braghetto I, Cortes C, Herquinigo D, et al. Evaluation of the radiological gastric capacity and evolution of the BMI 2–3 years after sleeve gastrectomy. Obes Surg. 2009;19(9):1262–9.

    Article  Google Scholar 

  9. 9.

    Baumann T, Grueneberger J, Pache G, et al. Three- dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration. Surg Endosc Other Interv Tech. 2011;25(7):2323–9.

    Article  Google Scholar 

  10. 10.

    Oor JE, Roks D, Unlu C, et al. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg. 2016;211(1):250–67.

    Article  Google Scholar 

  11. 11.

    Amor I, Debs T, Kassir R, et al. De novo hiata hernia of the gastric tube after sleeve gastrectomy. Int J Surg Case Rep. 2015;15:78–80.

    Article  Google Scholar 

  12. 12.

    Jones R, Junghard O, Dent J, et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2009;30:1030–8.

    Article  CAS  Google Scholar 

  13. 13.

    Espino A. Clasificación de Los Ángeles de esophagitis. Gastroenterol Latinoam. 2010;21(2):184–6.

    Google Scholar 

  14. 14.

    Braghettto I, Korn O. Late esophagogastric anatomic and functional changes after sleeve gastrectomy and its clinical consequences with regards to gastroesophageal reflux disease. Dis Esophagus. 2019;32(6)

  15. 15.

    Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;27(12):3092–101.

    Article  Google Scholar 

  16. 16.

    Hyun J, Bak Y. Clinical significance of hiatal hernia. Gut Liver. 2011;5(3):267–77.

    Article  Google Scholar 

  17. 17.

    Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26(10):2449–56.

    Article  Google Scholar 

  18. 18.

    Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13(4):568–74.

    Article  Google Scholar 

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Correspondence to Jorge Saba.

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Saba, J., Bravo, M., Rivas, E. et al. Incidence of de Novo Hiatal Hernia after Laparoscopic Sleeve Gastrectomy. OBES SURG 30, 3730–3734 (2020).

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  • Sleeve gastrectomy
  • Hiatal hernia
  • Gastroesophageal reflux