In patients with obesity, both sleeve gastrectomy + hiatal hernia repair and sleeve-fundoplication effectively resolve reflux and weight issues. However, sleeve gastrectomy + fundoplication demonstrates superior GERD control despite a higher rate of complications.

The objective of this systematic review and meta-analysis was to assess the effectiveness of combining sleeve gastrectomy (SG) with hiatal hernia repair (HHR) compared to combining SG with fundoplication (FP) in achieving remission of gastroesophageal reflux disease (GERD) among individuals with obesity.

Studies examining the impact of combining SG with HHR versus combining SG with FP on GERD after surgery were incorporated. An examination of the methodological quality of the incorporated trials was done. The rate of postoperative GERD, erosive esophagitis, and weight loss at 12 months were the major endpoints ascertained. Secondary endpoints encompassed mortality and postoperative complications. The PRISMA guidelines were followed.

Overall, 15 articles with 1164 subjects were incorporated in the meta-analysis. Notably, 554 volunteers underwent SG + HHR and 610 underwent SG + FP. In the SG + HHR group, 58.5 ± 28.9% of individuals experienced clinical GERD symptoms before the surgery, which decreased to 20.4 ± 17.5% after the procedure. For the SG + FP group, 64.8 ± 39.4% had GERD symptoms prior to surgery, which decreased to only 5 ± 8.1% postoperatively.

The SG + FP group showed considerably higher remission of GERD compared to the SG + HHR group. Both groups displayed comparable weight loss. The incidence of leaks was 0.18% in the SG + HHR group and 0.33% in the SG + FP group. Notably, the occurrence of perforations was significantly greater in the SG + FP group (3.1%) compared to the SG + HHR group (0%). Furthermore, the mortality rate was substantially higher in the SG + FP group (0.5%) compared to the SG + HHR group (0%).

Both approaches can be considered viable alternatives to conventional SG for individuals with obesity and concurrent hiatal hernia and/or GERD. Further robust research with longer follow-ups and direct comparisons to conventional SG is needed to provide more insights into these surgical methods.