To delineate the rate of hiatal hernia (HH) after sleeve gastrectomy (LSG).


A retrospective review was conducted of patients who underwent LSG from 2015-2018. Records were reviewed one year preoperatively and two years postoperatively to identify HH on imaging, endoscopy, or operative reports.


During 2015-2018, 545 patients underwent LSG as an index bariatric procedure. 1-year follow up was 82%, while 2-year follow up was 66%. 452 patients (82%) underwent preoperative endoscopy. 46 patients (8.4%) had a clinically significant HH detected intraoperatively, of which 44 underwent repair. An additional 77 patients (14%) had HH detected on preoperative endoscopy. Postoperatively, 184 patients (34%) underwent either endoscopy or an radiographic imaging. Prevalence of HH 2 years postoperatively was 29 (5.3% of included patients, 16% of patients with postoperative workup). 1 patient underwent HH repair after LSG. The rate of recurrent and/or persistent HH was significantly higher than the rate of de novo HH (11% vs. 4%, p=0.02). The rate of recurrent HH among patients who underwent HH repair during their index operation was also significantly higher than the rate of de novo HH (16% vs. 4%, p = 0.01). Having a HH prior to LSG was associated with significantly higher rates of reflux postoperatively (20% vs. 38%, p=0.02), though there was no association between reflux and postoperative HH.


Postoperative HH occurs in < 10% of patients at two years after LSG and is associated with preoperative HH. Preoperative HH is associated with higher rates of reflux after sleeve gastrectomy.