Can Hiatal Hernia Repair Be Done During Bariatric Surgery in Turkey?

For some patients, hiatal hernia repair and bariatric surgery can be performed during the same operation. This combined approach may be used with sleeve gastrectomy or Roux-en-Y gastric bypass when a hiatal hernia is identified and the surgical team considers repair appropriate.

In Short

• Yes, hiatal hernia repair can be performed during bariatric surgery in Turkey, including sleeve gastrectomy and Roux-en-Y gastric bypass.
• It is generally feasible in appropriately selected patients, but outcomes vary according to the hernia, reflux history, bariatric procedure, and surgical technique.
• Repair may improve reflux for some patients, but it does not guarantee that GERD will resolve or not develop after surgery.
• Patients with substantial or medically refractory GERD may be assessed for gastric bypass rather than sleeve gastrectomy.

Patients considering treatment in Turkey often ask whether repairing the hernia at the same time adds risk, whether it can prevent reflux, and whether sleeve gastrectomy or gastric bypass is the better option. The answer depends on factors including the size and type of the hernia, existing gastroesophageal reflux disease (GERD), the condition of the oesophagus and stomach, the selected bariatric procedure, and the surgeon’s experience.

Current evidence suggests that concurrent hiatal hernia repair is generally feasible and can be performed safely in suitable patients. However, the available research is largely observational, and outcomes are not identical for everyone. Hiatal hernia repair during bariatric surgery should therefore be planned after an individual assessment by a qualified bariatric and foregut surgeon.

What Is a Hiatal Hernia?

A hiatal hernia occurs when part of the stomach moves upward through the opening in the diaphragm where the oesophagus passes. This area is called the oesophageal hiatus. The change in anatomy may contribute to reflux symptoms because the normal barrier between the stomach and oesophagus can be affected.

Some people with a hiatal hernia have no noticeable symptoms. Others may experience heartburn, acid regurgitation, chest or upper abdominal discomfort, swallowing problems, or symptoms associated with GERD. Obesity can also be associated with reflux and may influence the decision about which bariatric procedure is most suitable.

A hernia may be found during preoperative investigations or identified during bariatric surgery. Its size and anatomy are important when deciding whether repair should be performed and which repair method may be appropriate.

Can Hiatal Hernia Repair Be Combined with Bariatric Surgery?

Yes. Hiatal hernia repair can be performed during sleeve gastrectomy or Roux-en-Y gastric bypass. When the surgeon considers repair clinically appropriate, the herniated stomach may be returned to its usual position and the opening in the diaphragm may be repaired as part of the same surgical procedure.

The combined operation may restore anatomy around the gastroesophageal junction while also treating obesity through the selected bariatric procedure. It can allow both conditions to be addressed during one planned operation rather than through separate surgeries.

A 2023 systematic review and meta-analysis reported that concurrent hiatal hernia repair with bariatric procedures was generally described as safe and effective, with no increase in mortality in the reviewed studies. However, the studies were heterogeneous. Some research found higher readmission or reoperation rates among patients undergoing sleeve gastrectomy with concurrent repair, so the combined approach should not be presented as risk-free or automatically suitable for every patient.

How Is the Combined Operation Performed?

The exact surgical plan varies according to the hernia and the bariatric procedure. In general, the surgeon assesses the hiatus and position of the stomach, reduces the herniated stomach when necessary, and repairs the diaphragmatic opening. The bariatric procedure is then performed or completed according to the agreed treatment plan.

Hiatal hernia repair with sleeve gastrectomy

During sleeve gastrectomy, part of the stomach is removed to create a narrower stomach. If a hiatal hernia is present, the surgeon may repair it during the same operation. A posterior crural repair, which involves closing part of the diaphragmatic opening, is one technique used in clinical practice. Primary suture repair or reinforcement materials may be considered depending on the anatomy and the surgeon’s judgement.

Repairing the hernia may improve reflux symptoms for some patients, but it does not guarantee that GERD will disappear or that it will not develop later. Sleeve gastrectomy can cause or worsen reflux in some individuals, even when a hiatal hernia has been repaired.

Hiatal hernia repair with Roux-en-Y gastric bypass

Roux-en-Y gastric bypass changes the route of food through the digestive system and is also a bariatric procedure. When combined with hiatal hernia repair, it may be considered for patients whose reflux is substantial or difficult to control, depending on the complete clinical evaluation.

For patients with medically refractory GERD and obesity, clinical guidance identifies Roux-en-Y gastric bypass with hiatal hernia repair as a possible approach in appropriate circumstances. This does not mean that gastric bypass is automatically the right choice. The decision should take account of medical history, reflux investigations, previous operations, nutritional considerations, and the patient’s ability to follow long-term follow-up and dietary guidance.

Will Repairing the Hernia Prevent Reflux?

Not necessarily. Hiatal hernia repair may improve reflux symptoms, particularly when the hernia contributes to the problem, but it cannot guarantee prevention or resolution of GERD. Reflux is influenced by more than the presence of a hernia, including the chosen bariatric procedure and the patient’s individual anatomy and physiology.

This issue is especially important when considering sleeve gastrectomy. Some comparative studies have reported persistent or new GERD after sleeve gastrectomy despite concomitant hiatal hernia repair. A Turkish retrospective study also found that the combined procedure was technically feasible, while symptomatic and new-onset GERD could still occur during follow-up.

Patients with significant pre-existing reflux, oesophagitis, or reflux that has not responded adequately to medical treatment may be considered for gastric bypass rather than sleeve gastrectomy. The choice should be individualized rather than based on the hernia repair alone.

Who May Be Considered for Combined Surgery?

Combined hiatal hernia repair and bariatric surgery may be considered for a patient who:

• Has obesity for which bariatric surgery is clinically appropriate;
• Has a confirmed hiatal hernia or a hernia identified during surgical assessment;
• May benefit from repair based on the hernia’s size, anatomy, or relationship to symptoms;
• Understands the possible benefits and limitations of repairing the hernia during the bariatric procedure;
• Can follow the recommended dietary, medication, activity, and follow-up plan after surgery.

This list is not a substitute for a medical consultation. A patient with mild or no reflux may have different options from someone with severe GERD or inflammation of the oesophagus. The bariatric operation should be selected after considering both weight-related health needs and upper gastrointestinal symptoms.

How Are Patients Evaluated Before Surgery in Turkey?

International patients should expect a structured preoperative assessment. The exact investigations differ between individuals and clinics, but the surgical team may review symptoms, previous treatments, weight-related conditions, prior abdominal operations, and any history of reflux or swallowing difficulties.

Depending on the clinical situation, the evaluation may include gastrointestinal investigations to assess the hernia, reflux, or oesophagus. Patients should provide a complete list of medications, previous medical reports, and details of earlier operations. If records are not in English, translated documentation may help the medical team understand the history accurately.

Before travelling, patients should ask which surgeon will perform the operation, whether a foregut or upper gastrointestinal specialist is involved, how the hernia will be assessed, and which bariatric procedure is being recommended. They should also clarify what happens if intraoperative findings differ from the initial assessment and how follow-up will be arranged after returning home.

Recovery and Aftercare

Recovery depends on the bariatric procedure, the hernia repair, the patient’s general health, and the presence of any postoperative concerns. After surgery, patients usually progress through the diet stages and activity instructions provided by their surgical team. These instructions should be followed carefully because the stomach and repaired hiatus require time to heal.

Patients travelling internationally should arrange appropriate accommodation and local support during the early recovery period. They should not plan a return journey without confirming that travel is suitable with the treating team. A clear discharge summary, medication list, emergency contact, and follow-up plan are particularly important for medical tourists.

Long-term follow-up remains important after bariatric surgery. Ongoing review may be needed to monitor weight-related health, reflux symptoms, nutrition, medication requirements, and symptoms that could suggest a recurrent or persistent problem. Patients who develop increasing pain, persistent vomiting, difficulty swallowing, bleeding, breathing problems, fever, or worsening reflux should contact their medical team promptly.

Risks and Limitations

As with any operation, combined bariatric surgery and hiatal hernia repair has potential risks. These may include complications related to anaesthesia, bleeding, infection, injury to nearby structures, leakage, blood clots, narrowing, persistent symptoms, or the need for further treatment. The specific risk profile depends on the patient and the surgical procedure.

The medical literature does not establish one universally superior repair technique for every hiatal hernia. The decision about primary suture repair, reinforcement materials, and the type of bariatric surgery should be based on hernia anatomy, reflux status, surgical expertise, and individual risk factors. Evidence regarding mesh or other reinforcement materials remains limited in several clinical settings, so patients may wish to ask why a particular method is being recommended.

There is no strong evidence that outcomes are uniquely different in Turkey compared with other countries. Turkish studies and surgeon surveys confirm that simultaneous hiatal hernia repair is performed in Turkish bariatric practice, but important factors include the patient’s suitability, the quality of evaluation, the surgeon’s experience, and the availability of appropriate follow-up.

Sleeve Gastrectomy or Gastric Bypass?

The presence of a hiatal hernia does not by itself determine the bariatric procedure. Sleeve gastrectomy with hernia repair may be considered for selected patients when the reflux profile and anatomy are suitable. However, reflux can persist or develop after sleeve gastrectomy.

Roux-en-Y gastric bypass may be considered when obesity is accompanied by substantial or medically refractory GERD, depending on the full assessment. It may address both weight-related disease and reflux-related concerns, but it is a different operation with its own long-term requirements and risks.

Patients should discuss how their reflux history affects the recommendation, what limitations are expected, whether additional testing is needed, and what long-term follow-up will be available in Turkey and in their home country.

Frequently Asked Questions

Is hiatal hernia repair always performed during bariatric surgery?

No. The decision depends on whether a hernia is present, its size and anatomy, the patient’s symptoms, and the surgeon’s assessment. Repair is not automatically required for every patient undergoing bariatric surgery.

Can a hiatal hernia return after repair?

Recurrence is possible after hiatal hernia repair. The available research does not support presenting combined surgery as a permanent guarantee against recurrence or reflux. Patients should discuss factors that may affect their individual risk with their surgeon.

Is sleeve gastrectomy suitable if I have GERD?

It may be suitable for some patients, but GERD should be assessed carefully. Sleeve gastrectomy may improve reflux in certain cases when combined with hernia repair, but it can also leave reflux unchanged or worsen it. Patients with significant or medically refractory GERD may be considered for gastric bypass instead.

Can international patients have this operation in Turkey?

International patients can be assessed for combined surgery in Turkey, but suitability must be determined by the treating medical team. Before travelling, confirm the surgeon’s qualifications, the proposed procedure, the preoperative tests, the follow-up arrangements, and what support is available if symptoms occur after returning home.

Conclusion

Hiatal hernia repair can be performed during bariatric surgery in Turkey, including sleeve gastrectomy and Roux-en-Y gastric bypass. The combined approach is commonly reported in medical practice and is generally feasible for appropriately selected patients.

However, repairing the hernia does not guarantee that reflux will resolve, particularly when sleeve gastrectomy is selected. Patients with significant GERD may need careful consideration of gastric bypass and additional reflux evaluation. The most appropriate plan depends on the hernia’s anatomy, the patient’s symptoms, the chosen bariatric operation, and the experience of the surgical team.

Estexper Clinic recommends discussing all treatment options with a qualified bariatric and foregut surgeon before making travel or surgical arrangements. A personalized assessment is essential for determining whether combined hiatal hernia repair and bariatric surgery is appropriate.

Medical References

• Guidelines for the Management of Comorbidities Relevant to Metabolic and Bariatric Surgery — Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).
• Outcomes of Concurrent Hiatus Hernia Repair with Different Bariatric Surgery Procedures: a Systematic Review and Meta-analysis — Obesity Surgery; indexed in PubMed and available through PMC.
• Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass — Surgery for Obesity and Related Diseases.
• The Effect of Laparoscopic Sleeve Gastrectomy With Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease — Cureus; study from Fulya Acibadem Hospital, Istanbul, Turkey.
• Practices concerning sleeve gastrectomy in Turkey: A survey of surgeons — Turkish Journal of Surgery.
• Guidelines for the Surgical Treatment of Hiatal Hernias — Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).