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To explore the relationship between preoperative Hill Grade and gastroesophageal reflux disease (GERD) outcomes two years after sleeve gastrectomy (SG).


All patients (n=275) undergoing SG performed by 3 surgeons at a single academic institution from June 2018 to August 2019 were included. Complete datasets were available for 134 patients which were incorporated in analyses. Patients with preoperative Hill Grade I-II (Group1;n=90) were compared to those with Grade III-IV (Group2;n=44). Univariable analyses were conducted for potential associations between Hill Grade and GERD outcomes.


Baseline demographics, weight, obesity-associated diseases including GERD (33.33%vs. 45.45%;p=1747), and follow-up length were similar between groups. Hiatal hernia (HH) was more common in Group2 (61.36%vs.14.44%;p<0.0001). HH repair (HHR) at index SG occurred more frequently in Group2 (31.82%vs.8.89%;p=0.0008). Change in body mass index did not vary between groups (-12.52+-6.91vs.-13.15+-5.87kg/m2;p=0.5762). At two-year follow-up, the percentages of patients who had GERD (53.33%vs.70.45%;p=0.0595), remained GERD free (55.00%vs.45.83%;p=0.4498), had resolution of GERD (30.00%vs.10.00%;p=0.0978), experienced persistent GERD (66.67%vs.85.00%;p=0.1518), or suffered from de novo GERD (46.67%vs.58.33%;p=0.3372) did not statistically differ between Group1 and Group2. Two patients in Group1 and one in Group2 underwent additional operative intervention for GERD refractory to medical therapy (2.22%vs.2.27%;p=0.9854).


This is the first study assessing the impact of Hill Grade on GERD after SG. Univariable analyses of this small sample did not show a statistically significant difference in postoperative GERD outcomes between patients with preoperative Hill Grade I-II and those with Grade III-IV. Larger-sample studies allowing more robust analyses accounting for the impact of HHR are needed.