Is Posoperative Hiatal Hernia an Issue After Slevee Gastrectomy?

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.

To determine the incidence of de novo HH one year after LSG and its independent association with esophagitis and GERD- related symptoms.

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.

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.

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.