Background and Aims Obesity patients are often complicated with hiatal hernia and gastroesophageal reflux symptoms, which may cause severe complications after sleeve gastrectomy. The robot-assisted system has the advantages of a short and gentle learning curve, a transparent and three-dimensional surgical field of vision, and accurate and stable surgical operation, which has been widely promoted in the surgical field. This study assessed the feasibility of robot-assisted sleeve gastrectomy plus Nissen fundoplication surgery to provide a better treatment scheme for obese patients with hiatal hernias.Methods The clinical data of 49 patients with obesity and concomitant hiatus hernia undergoing sleeve gastrectomy plus fundoplication surgery between March 2019 and December 2021 were retrospectively reviewed. Of the patients, 22 cases underwent robot-assisted sleeve gastrectomy combined with fundoplication (robotic group), and 27 cases underwent laparoscopic-assisted sleeve gastrectomy combined with fundoplication (laparoscopic group). The differences in perioperative clinical variables between the two groups were compared, and the treatment efficacy in the robotic group was analyzed.Results There were no significant differences in preoperative triglyceride level, preoperative fasting glucose level, length of postoperative hospital stay, and incidence of complications between the two groups (all P>0.05). In the robotic group compared to the laparoscopic group, the average total operation duration was prolonged (169.09 min vs. 143.33 min, P=0.023) and the average surgical cost was increased (63 600 yuan vs. 54 000 yuan, P<0.001), but the average operative time was shortened (115.09 min vs.134.19 min, P=0.047), and the average blood loss was reduced (25.45 mL vs. 40.00 mL, P=0.023). there were no statistical differences in BMI, percentage of excess weight loss (%EWL), triglyceride level, fasting blood glucose level, and GERD score between the two groups at one month after operation (all P>0.05). In robotic group at 1 month after the operation, the %EWL value (26.26%) reached the weight loss goal, and the weight, BMI, triglyceride level, fasting blood glucose level and GERD score were significantly decreased compared with the preoperative values (all P<0.05).Conclusion Robot-assisted sleeve gastrectomy combined with fundoplication surgery yields good weight loss results and significantly improves the metabolic and gastroesophageal reflux symptoms in obese patients with hiatal hernia, and is safe and reliable, with certain feasibility. However, there is still an urgent problem of high surgical cost, and the patient's family economic situation should be fully considered when choosing the surgical approach.