Long-Term Anatomical Durability and Clinical Outcomes of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair: Up to 10-Year Multicenter Analysis

BACKGROUND: Hiatal hernia is common in patients with severe obesity undergoing metabolic bariatric surgery. Although concomitant hiatal hernia repair during laparoscopic sleeve gastrectomy has been widely adopted, long-term data beyond 5 years remain limited, and the clinical relevance of anatomical recurrence is still poorly defined. OBJECTIVES: To evaluate the 10-year recurrence rate, predictors of failure, and clinical outcomes following concomitant sleeve gastrectomy and hiatal hernia repair. METHODS: This retrospective multicenter cohort study analyzed 111 patients who underwent sleeve gastrectomy with concomitant hiatal hernia repair between 2014 and 2015. Complete-case analysis included only patients with assessable recurrence status at follow-up. The primary outcome was anatomical recurrence (> 2 cm transhiatal migration of the gastric sleeve). Secondary outcomes included reintervention, gastroesophageal reflux disease (GERD), and weight loss. RESULTS: Among 111 patients, 108 were analyzed. Mean age was 50.1 ± 11.6 years, 80.6% female, mean baseline BMI 42.7 ± 5.8 kg/m², and mean follow-up was 93.0 ± 22.7 months (7.7 ± 1.9 years). Hernia recurrence occurred in 14 patients (13.0%). Among these, 5 (35.7%) underwent reintervention, while 9 (64.3%) were managed conservatively. Freedom from recurrence was 98.1% at 5 years and 68.9% at 10 years, although the 10-year estimate should be interpreted cautiously. Hernia size ≥ 5 cm and postoperative GERD were associated with recurrence (OR 5.0; 95% CI 1.2-20.0; P=0.035; OR 4.97; 95% CI 1.56-17.53; p = 0.008). Reintervention was required in 11 patients (10.2%), all with symptomatic GERD. CONCLUSIONS: Concomitant sleeve gastrectomy and hiatal hernia repair were associated with acceptable long-term outcomes in this multicenter cohort. Reintervention was more often associated with postoperative reflux-related symptoms than with anatomical recurrence alone, while many anatomical recurrences were managed conservatively.