Comparing Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass with Hiatal Repair for Severe Obesity and GERD: Short-Term Outcomes

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are common bariatric procedures. In patients with obesity and gastroesophageal reflux disease (GERD), simultaneous hiatal hernia repair (HHR) is often indicated. However, the comparative outcomes of LSG+HHR and LRYGB+HHR remain unclear.Objectives: To compare short-term outcomes of LSG+HHR versus LRYGB+HHR in terms of weight loss, GERD remission, comorbidity resolution, and perioperative parameters.Methods: Seventy-nine patients with obesity and hiatal hernias were retrospectively analyzed; 37 underwent LSG+HHR and 42 underwent LRYGB+HHR. Primary outcomes were GERD remission, excess weight loss percentage (EWL%), and excess BMI loss percentage (EBMIL%). Secondary outcomes included operative time, hospital stay, comorbidity resolution, and quality of life (QoL) improvement at one year.Results: LRYGB+HHR achieved significantly greater weight loss at 6 and 12 months (P < 0.001) and higher GERD remission rates (83.8% vs. 61.1%, P < 0.001) with fewer recurrences compared to LSG+HHR. However, LRYGB+HHR had longer operative time (166.74 vs. 68.73 minutes, P < 0.001) and hospital stay (2.24 vs. 1.05 days, P < 0.001). Both procedures effectively improved comorbidities and QoL (P > 0.05).Conclusions: LRYGB+HHR offers superior outcomes in GERD resolution and weight loss but at the cost of longer operative time and hospitalization. Both procedures effectively improve comorbidities and QoL. Surgical choice should be individualized based on patient characteristics.