Introduction
Did you know that up to 50% of patients with obesity also have a Hiatal Hernia? If you are considering Sleeve Gastrectomy and have been diagnosed with (or suspect) a Hiatal Hernia, you may be wondering how these two conditions interact and whether they can be addressed together.
The good news: They can and should be treated together. I am Op. Dr. Mustafa Erol. In my 35+ years of surgical experience, I routinely combine Hiatal Hernia repair with Sleeve Gastrectomy to provide patients with a complete solution in a single operation.
Understanding Hiatal Hernia
What is a Hiatal Hernia?
A Hiatal Hernia occurs when the upper portion of your stomach pushes up through the diaphragm — the muscle separating your chest from your abdominal cavity. This happens at the hiatus, the natural opening through which your esophagus passes.
Types of Hiatal Hernia
- Type I - Sliding (Most Common, ~95%):
- The stomach slides up and down through the hiatus
- Often associated with reflux disease (GERD)
- Can be intermittent
- Type II-IV - Paraesophageal:
- A portion of the stomach pushes out alongside the esophagus
- More serious, may require repair even without symptoms
- Can lead to complications if untreated
Hiatal Hernia Symptoms
Many Hiatal Hernias do not cause any symptoms. When symptoms occur, they may include:
- Heartburn and reflux
- Food or liquid coming back into the mouth
- Difficulty swallowing
- Chest pain
- Feeling full early
- Shortness of breath after eating
- Belching
The Connection Between Obesity and Hiatal Hernia
Why Do They Often Occur Together?
Obesity increases the risk of Hiatal Hernia through the following ways:
1. Increased intra-abdominal pressure: Excess weight pushes upward on the stomach 2. Weakened diaphragm: Chronic pressure can weaken the hiatus 3. Fat accumulation: Visceral fat around the stomach affects positioning 4. Postural changes: Weight distribution affects trunk mechanics
Statistics
- 40-50% of obese patients have some degree of Hiatal Hernia
- Many are discovered incidentally during bariatric surgery evaluation
- Small hernias may be asymptomatic but can worsen after Sleeve Gastrectomy
Why Repair a Hiatal Hernia During Sleeve Gastrectomy?
The Problem: Sleeve Gastrectomy Can Worsen Reflux
Sleeve Gastrectomy creates a narrow, high-pressure stomach:
- If an existing Hiatal Hernia is not repaired:
- Reflux becomes more likely
- Medication or future surgery may be required
- Can severely affect quality of life
The Solution: Combined Surgery
Repairing the Hiatal Hernia during Sleeve Gastrectomy:
The Combined Procedure
What Happens During Surgery?
Step 1: Hiatal Hernia Repair 1. The Hiatal Hernia is identified 2. The stomach is returned to the abdominal cavity 3. The enlarged hiatus is closed (crural repair) 4. Reinforced with mesh if needed (for large hernias)Step 2: Sleeve Gastrectomy 1. The stomach is mobilized 2. A vertical tube is created 3. 75-80% of the stomach is removed 4. Leak test is performedSurgical Details
| Aspect | Combined Procedure |
|---|---|
| Duration | 60-90 minutes |
| Approach | Laparoscopic (closed) |
| Incisions | 4-5 small (each <1 cm) |
| Hospital stay | 1-2 nights |
| Additional risk | Minimal compared to Sleeve Gastrectomy alone |
When is Mesh Used?
For large Hiatal Hernias (>5 cm), mesh reinforcement may be performed:
Advantages of the Combined Approach
One Surgery, Complete Solution
- For you:
- One anesthesia
- One recovery period
- Lower total cost than two separate surgeries
- Less time away from work/life
- Medically:
- Better long-term outcomes
- Lower reflux rates after Sleeve Gastrectomy
- Comprehensive treatment
- Prevents the need for future surgery
Expected Outcomes
- Weight Loss:
Same as standard Sleeve Gastrectomy:
- 60-70% of excess weight loss
- Results achieved within 12-18 months
- Metabolic health improvements
- Reflux Improvement:
- Significant reduction in GERD symptoms
- Many patients can stop reflux medications
- Better quality of life
Who Needs Combined Surgery?
Must Be Repaired
- Hiatal Hernia detected on imaging or endoscopy
- Significant GERD complaints before surgery
- Large Hiatal Hernia (>3 cm)
May Require Repair (Decided During Surgery)
- Smaller hernias discovered during Sleeve Gastrectomy
- Borderline cases assessed intraoperatively
May Not Require Repair
- No evidence of hernia on evaluation
- Very small, asymptomatic hiatal widening
*In my practice, I evaluate every patient before surgery and make the final decision based on intraoperative findings. This approach ensures no hernia is missed.*
Recovery After Combined Surgery
Hospital Stay
Similar to standard Sleeve Gastrectomy:
Diet Phases
Same as standard Sleeve Gastrectomy protocol:
Special Considerations
After Hiatal Hernia repair:
Long-Term Outcomes
Success Rates
| Outcome | Percentage |
|---|---|
| Weight loss similar to standard Sleeve Gastrectomy | 95%+ |
| Reduced GERD compared to Sleeve Gastrectomy alone | Significant improvement |
| Hernia recurrence | 5-10% long-term |
| Satisfaction | High |
Possible Issues
- Hernia Recurrence:
- Can occur in 5-10% of patients over years
- More common if initial hernia was large
- Generally manageable
- Persistent Reflux:
- Mild reflux can persist in some patients
- Generally better than the picture without repair
- Occasional medication may be needed
Frequently Asked Questions
Does combining procedures make surgery riskier?
Adding Hiatal Hernia repair to Sleeve Gastrectomy introduces minimal additional risk. The procedures are done using the same incisions, and the repair is performed before the sleeve is created. Recovery is essentially the same.
What if my hernia is found during surgery?
This is very common. If I discover a Hiatal Hernia during your Sleeve Gastrectomy, I repair it then and there — one reason it is important to choose an experienced surgeon. A second surgery is not required.
Can Sleeve Gastrectomy be performed if I have had Hiatal Hernia repair before?
Yes, but it is more complex due to scar tissue. If you have had a previous hernia repair, let us know for planning. It is generally still possible to safely perform Sleeve Gastrectomy.
Does the hernia repair affect how much weight I will lose?
No. Hiatal Hernia repair does not affect the weight loss mechanism of Sleeve Gastrectomy. You can expect the same results as the standard Sleeve Gastrectomy procedure.
What if I need Reflux Surgery after Sleeve Gastrectomy?
If GERD develops or persists after Sleeve Gastrectomy (despite hernia repair), conversion to Gastric Bypass is the most effective solution. This approach both definitively addresses reflux and provides additional weight loss.
My Approach
*"In my 35+ years of bariatric surgery experience, I have learned that addressing all problems at the same time provides the best outcomes. When I perform Sleeve Gastrectomy, I carefully assess for Hiatal Hernia and repair it when present. This comprehensive approach means fewer surprises and better long-term results for my patients."*
Two Problems, One Solution
If you have both obesity and a Hiatal Hernia, combined surgery offers the most efficient and effective treatment. Rather than addressing these conditions that can be solved together separately, prefer to handle them in one go.
Ready to learn more?Book your consultation:
- Phone / WhatsApp: +90 532 293 99 39
- Email: info@doktormustafaerol.com
*Last Updated: January 2026*
*This content is for informational purposes only. For personalized medical advice, please consult a qualified surgeon.*