The obesity is a global epidemic of which prevalence increases. The obesity is a well-documented risk factor for many health conditions, including the cardiovascular disease, type-2 diabetes mellitus, osteoarthritis, and some cancers. Moreover, the gastroesophageal reflux disease (GERD) is a common condition in the obese patients.

The pathophysiology of the GERD in adults is thought to be multifactorial. It is caused by the abnormal relaxation of the lower esophageal sphincter or a mix of the inherited and functional factors arising from the increased pressure from the stomach.

The patients can usually apply with the atypical symptoms such as cough, sinusitis and pharyngitis such as heartburn, acid or water regurgitation, dysphagia and odynophagia.

The non-treatable GERD can result in the reflux erosive esophagitis, ulceration, strictures, and Barrett's esophagus. 10% of Barrett's esophagus cases can progress to the esophageal adenocarcinoma.

The research has shown that the GERD responds differen reactions to the bariatric surgery, depending on which surgery is performed. Therefore, the evaluation of all patients in terms of the GERD before the surgery is important in the preparation for the bariatric surgery. Accordingly, the preoperative upper gastrointestinal endoscopy is essential for all bariatric surgery patients.

In the patients who did not undergo simultaneous hiatal hernia repair with the sleeve gastrectomy (gastric sleeve surgery), it is observed that the reflux complaints increase to the reduction in the gastric emptying depending on the surgery, the decrease in the lower esophageal sphincter pressure, the blunt in terms of feeling angle, the herniation of a part of the newly formed stomach into the thoracic cavity, the decrease in the gastric volume, and the increase of the entogastric pressure that is secondary to the narrow stomach pouch. The role of the hiatal hernia repair in the sleeve gastrectomy is an important consideration for the patients with reflux. It is observed that the reflux complaints regress at a rate of 94% in the patients who underwent hiatal hernia repair simultaneously with the sleeve gastrectomy surgery.

The gastric bypass is accepted as the most effective bariatric procedure for the reflux. In the studies conducted, it has been determined that the clinical improvement and symptoms were not observed in terms of the reflux in all patients who underwent gastric bypass surgery in long-term follow-up.

The gastric bypass is our first preferred method, especially in the patients with the resistant reflux complaint. However, for other reflux patients, the simultaneous hiatal hernia repair with the sleeve gastrectomy will usually be sufficient.