Hiatal hernia repair after sleeve gastrectomy is a revisional bariatric procedure performed for patients who develop or worsen a hiatal hernia after sleeve gastrectomy, leading to GERD, regurgitation, aspiration, heartburn, or reflux‑related complications. The procedure reduces the herniated stomach, repairs the hiatal defect with cruroplasty, and may include concurrent sleeve revision or conversion to gastric bypass for patients with severe or refractory reflux.

The stomach is reduced from the mediastinum, and the hiatal opening is repaired by approximating the crura with non‑absorbable sutures. Mesh may be used for large defects. If reflux persists after cruroplasty alone, concurrent conversion to gastric bypass may be performed to provide definitive reflux control. Sleeve revision may be added if dilation is present.

Benefits include resolution or significant improvement in GERD, reduced regurgitation, improved sleep, reduced aspiration risk, and correction of the anatomical defect responsible for reflux. Patients with severe GERD often experience immediate symptom relief.

Candidates include sleeve gastrectomy patients with confirmed hiatal hernia on imaging or endoscopy, symptomatic GERD, regurgitation, aspiration, Barrett‑related findings, or refractory reflux despite medication. Patients with recurrent hernias after prior repair are also candidates.

The procedure is performed laparoscopically. The hernia is reduced, the esophagus is mobilized, and the crura are approximated with non‑absorbable sutures. Mesh is used selectively. Concurrent sleeve revision or bypass conversion is performed when indicated.

Risks include bleeding, dysphagia, recurrent hernia, reflux persistence, and, if conversion is performed, anastomotic complications. Revisional surgery carries slightly higher risk due to scar tissue.

Days 1–3: hydration, ambulation, pain control. Week 1: liquids. Week 2: soft foods. Weeks 3–4: gradual return to normal routines. GERD symptoms typically improve rapidly.

Most patients experience significant improvement in reflux symptoms. Recurrent hernias are possible but less common with proper cruroplasty technique. Patients with severe GERD may achieve complete resolution after concurrent bypass conversion.

Dr. Nestor de la Cruz‑Muñoz is a nationally recognized bariatric and metabolic surgeon with extensive experience repairing hiatal hernias in post‑bariatric patients. His expertise ensures safe hernia reduction, durable cruroplasty, and optimal reflux outcomes.

Weight loss is not the primary goal. If concurrent bypass conversion is performed, patients may lose 20–28% of total body weight over 12–18 months.

Hiatal hernia repair improves reflux and esophageal health. If combined with bypass conversion, significant metabolic improvements are expected.

Protein‑forward nutrition, resistance training, and consistent metabolic follow‑up are essential after hiatal hernia repair and any concurrent revision.

Gastric bypass provides the best reflux control for patients with persistent GERD after cruroplasty alone. Hiatal hernia repair is the first‑line surgical option for anatomically confirmed hernias.

If cruroplasty alone does not resolve reflux, conversion to gastric bypass is the preferred next step for definitive reflux control.

Patients are guided to prioritize protein intake, resistance training, hydration, and body composition monitoring to protect lean mass after revision.

Most insurers cover hiatal hernia repair when symptoms and hernia are confirmed by imaging or endoscopy. Requirements may include prior trial of proton pump inhibitors.

Pre‑op requirements may include bloodwork, imaging, endoscopy, pH study, nutrition consultation, and medication adjustments.

Nutrition progresses from liquids to soft foods. Protein goals and vitamin supplementation are maintained.

Early walking begins immediately. Light activity continues through week 2. Resistance training begins at week 4–6.

Miami is a major hub for patients from Latin America and the Caribbean. Our team supports travel coordination and virtual follow‑up.