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Related Concept Videos

Hiatal Hernia01:25

Hiatal Hernia

A hiatal hernia is the abnormal protrusion of the stomach or other abdominal organs through the esophageal hiatus of the diaphragm into the thoracic cavity.Normally, the gastroesophageal junction (GEJ) lies below the diaphragm and is supported by the phrenoesophageal membrane, the diaphragmatic crura, and connective tissues. Weakening of these structures—due to aging, congenital defects like a short esophagus, or increased intra-abdominal pressure from coughing, obesity, pregnancy, or heavy...
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Late hiatal hernia after Roux-en-Y gastric bypass: a systematic review.

Pedro Bicudo Bregion1, Josélio Rodrigues de Oliveira-Filho2, João Gabriel Romero Braga3

  • 1Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil.

Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery
|June 30, 2026
PubMed
Summary

Obesity surgery like Roux-en-Y gastric bypass (RYGB) can lead to late hiatal hernias (HH). These hernias cause reflux and obstructive symptoms, but surgical repair offers good symptom resolution rates.

Keywords:
Bariatric surgeryGastro-esophageal reflux diseaseHiatal herniaObesityRoux-en-Y gastric bypass

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Published on: September 11, 2021

Area of Science:

  • Bariatric Surgery
  • Gastroenterology
  • Surgical Outcomes

Background:

  • Obesity is a global health concern linked to gastroesophageal reflux disease (GERD) and hiatal hernia (HH).
  • Increased intra-abdominal pressure in obesity exacerbates GERD and HH.
  • Roux-en-Y gastric bypass (RYGB) is a common bariatric procedure, but can lead to late symptomatic HH and pouch migration.

Purpose of the Study:

  • To review the literature on late hiatal hernia (HH) after Roux-en-Y gastric bypass (RYGB).
  • To analyze symptom presentation, diagnostic methods, and surgical management of HH post-RYGB.
  • To evaluate outcomes including symptom resolution and recurrence rates.

Main Methods:

  • A systematic literature search was performed using PubMed, EMBASE, and Cochrane Central databases.
  • Studies focusing on late hiatal hernia (HH) occurring after Roux-en-Y gastric bypass (RYGB) were included.
  • Outcomes for symptom resolution, recurrence, and operative characteristics were pooled; a meta-analysis was not feasible due to heterogeneity.

Main Results:

  • HH after RYGB commonly presents with GERD (39-93.6%), obstructive symptoms (29-88%), and abdominal pain (28.6-71%).
  • Contrast-enhanced imaging showed the highest diagnostic accuracy.
  • Surgical management, often primary cruroplasty with or without mesh/fundoplication, resulted in symptom resolution rates of 42.9-100% and HH recurrence of 5-6.54%.

Conclusions:

  • Late HH following RYGB significantly contributes to obstructive and reflux symptoms.
  • Surgical intervention generally leads to good symptom improvement, though long-term monitoring is necessary.
  • Bioabsorbable mesh may potentially decrease recurrence rates.