Gastroesophageal reflux disease (GERD) is common in the morbidly obese population, and hiatal hernias are encountered in 20% to 52% of patients. Primary surgical repair of hiatal hernias, in particular the paraesophageal type, is associated with a higher recurrence rate in obese patients. Concomitant weight loss surgery may be advisable. Combined sleeve gastrectomy and paraesophageal hiatal hernia repair is feasible but can induce or worsen preexisting GERD. A Roux-en-Y gastric bypass offers advantages of more pronounced excess weight loss and better symptom control, albeit with a potentially higher rate of morbidity compared with paraesophageal hernia repair alone or sleeve gastrectomy.
Keywords: Bariatric surgery; Hiatal hernia; Lower esophageal sphincter; Reflux.
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