Hiatal Hernia Size and De Novo Gastroesophageal Reflux Disease After Sleeve Gastrectomy: A Single-Center Retrospective Study
- 1Hospital Central Norte de Petroleos Mexicanos
Abstract
BackgroundSleeve gastrectomy is the most frequently performed bariatric procedure worldwide but is associated with the development of de novo gastroesophageal reflux disease (GERD). Hiatal hernia has been identified as a relevant anatomical factor in postoperative reflux, although most studies evaluate it dichotomously without analyzing whether its size influences GERD risk. The aim was to evaluate the association between preoperative hiatal hernia size and de novo GERD after sleeve gastrectomy.
MethodsRetrospective, single-center, observational study of patients undergoing sleeve gastrectomy at Hospital Central Norte de Petroleos Mexicanos (2018-2025). Demographic and clinical characteristics, endoscopic classification of hiatal hernia size (small <2 cm, medium 2.1-4 cm, large >4 cm), and evidence of de novo GERD were analyzed using descriptive statistics, Fishers exact test, odds ratio (OR) estimation with 95% confidence intervals (CI), and binary logistic regression. Statistical significance was set at p<0.05.
ResultsFifty-six patients were included (mean age 48.3 {+/-} 8.1 years; 67.9% male). Hiatal hernia classification was conclusive in 46 patients (82.1%): 63.0% no hernia, 4.3% small, 30.4% medium, and 2.2% large. De novo GERD occurred in 14.0% of patients without preexisting GERD (6/43). No significant association was found between hiatal hernia size and de novo GERD (Fisher p=0.515). In the reduced logistic model, neither hiatal hernia (medium/large vs. absent/small; OR 3.47; 95% CI 0.50- 29.43; p=0.207) nor age (OR 1.02; 95% CI 0.90-1.13; p=0.754) was significantly associated. No evaluated factor (sex, smoking, alcohol, age) reached significance.
ConclusionsIn this cohort, no statistically significant association was demonstrated between preoperative hiatal hernia size and de novo GERD after sleeve gastrectomy; however, the low number of events limits the ability to exclude a clinically relevant association. These findings are compatible with a multifactorial mechanism rather than with the isolated presence of this finding. Prospective studies with larger sample sizes and standardized reflux assessment instruments are required to confirm these results.
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BibTeX
@misc{almeida2026hiatal,
title = {{Hiatal Hernia Size and De Novo Gastroesophageal Reflux Disease After Sleeve Gastrectomy: A Single-Center Retrospective Study}},
author = {E. R. Ricarte Almeida and C. J. Mata Quintero and J. Sesma Chazaro and C. Peralta Rivera and C. D. Arteaga Gonzalez},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.31.26361833},
url = {https://www.medrxiv.org/content/10.64898/2026.08.31.26361833v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Hiatal Hernia Size and De Novo Gastroesophageal Reflux Disease After Sleeve Gastrectomy: A Single-Center Retrospective Study
AU - E. R. Ricarte Almeida
AU - C. J. Mata Quintero
AU - J. Sesma Chazaro
AU - C. Peralta Rivera
AU - C. D. Arteaga Gonzalez
PY - 2026
DA - 2026/08/31
PB - medRxiv
DO - 10.64898/2026.08.31.26361833
UR - https://www.medrxiv.org/content/10.64898/2026.08.31.26361833v1
AB - BackgroundSleeve gastrectomy is the most frequently performed bariatric procedure worldwide but is associated with the development of de novo gastroesophageal reflux disease (GERD). Hiatal hernia has been identified as a relevant anatomical factor in postoperative reflux, although most studies evaluate it dichotomously without analyzing whether its size influences GERD risk. The aim was to evaluate the association between preoperative hiatal hernia size and de novo GERD after sleeve gastrectomy. MethodsRetrospective, single-center, observational study of patients undergoing sleeve gastrectomy at Hospital Central Norte de Petroleos Mexicanos (2018-2025). Demographic and clinical characteristics, endoscopic classification of hiatal hernia size (small <2 cm, medium 2.1-4 cm, large >4 cm), and evidence of de novo GERD were analyzed using descriptive statistics, Fishers exact test, odds ratio (OR) estimation with 95% confidence intervals (CI), and binary logistic regression. Statistical significance was set at p<0.05. ResultsFifty-six patients were included (mean age 48.3 {+/-} 8.1 years; 67.9% male). Hiatal hernia classification was conclusive in 46 patients (82.1%): 63.0% no hernia, 4.3% small, 30.4% medium, and 2.2% large. De novo GERD occurred in 14.0% of patients without preexisting GERD (6/43). No significant association was found between hiatal hernia size and de novo GERD (Fisher p=0.515). In the reduced logistic model, neither hiatal hernia (medium/large vs. absent/small; OR 3.47; 95% CI 0.50- 29.43; p=0.207) nor age (OR 1.02; 95% CI 0.90-1.13; p=0.754) was significantly associated. No evaluated factor (sex, smoking, alcohol, age) reached significance. ConclusionsIn this cohort, no statistically significant association was demonstrated between preoperative hiatal hernia size and de novo GERD after sleeve gastrectomy; however, the low number of events limits the ability to exclude a clinically relevant association. These findings are compatible with a multifactorial mechanism rather than with the isolated presence of this finding. Prospective studies with larger sample sizes and standardized reflux assessment instruments are required to confirm these results.
ER -