The surgical procedures for the obese patients with hiatus hernia and reflux symptoms

[Background] In the sleeve gastrectomy for the bariatric surgery, the postoperative reflux symptoms often become the problem for the patients with hiatus hernia and/or preoperative reflux esophagitis. Current literatures of bariatric surgery for the obese patients with hiatus hernia and/or the reflux esophagitis is reviewed. [Method], In March, 2016, the Pubmed search is used for the words "(bariatric or obesity or obese) ("reflux disease" or "GORD" or "GERD" or "hiatus hernia") ("bariatric surgery" or "gastric bypass" or "sleeve gastrectomy" or "duodenal switch")". [Result] 334 articles are searched. And the articles was investigated thoroughly, there was not Meta-analysis, and there were 18 reports of clinical trials and 15 reports of systematic (narrative) review. As for the primary closure of the crus, good symptomatic outcomes for the reflux were reported, and the use of Mesh was controversial. There was not the report that had high evidence level indicating the usefulness of the operation of bypass procedures. [Conclusion] The use of the Mesh and bypass procedures do not have enough evidence. Primary closure of the crus of diaphragm is capable of being recommended generally because of the simplicity for the technical aspect. A future study constructing the evidence is waited.