Background and Aims Gastroesophageal reflux disease (GERD) is a common complication following sleeve gastrectomy (SG), particularly in patients with concomitant hiatal hernia, where symptoms tend to be more persistent and refractory, significantly impairing postoperative quality of life. This study aimed to evaluate the efficacy of laparoscopic hiatal hernia repair combined with gastroesophageal fixation in SG patients with severe GERD and hiatal hernia, providing clinical reference for revisional surgical strategies.Methods The clinical data of 9 patients with severe GERD after SG who underwent laparoscopic hiatal hernia repair and gastroesophageal fixation at Huashan Hospital, Fudan University, between January 2023 and June 2024 were retrospectively analyzed. GerdQ scores, proportion of endoscopically confirmed reflux esophagitis, and proton pump inhibitor (PPI) usage were compared before and after surgery. Surgical parameters and follow-up outcomes were also recorded.Results All patients successfully completed the surgery without major intraoperative complications, and the mean postoperative hospital stay was 5.22 d. After a mean follow-up period of 15.27 months, the GerdQ score significantly decreased from 11.67±2.00 to 7.22±1.48. The proportion of patients with GerdQ score≥8 decreased from 100.00% to 44.44%, and the rate of endoscopically confirmed GERD dropped from 88.89% to 11.11%; PPI use also significantly declined, with all differences reaching statistical significance (all P<0.05).Conclusion Laparoscopic hiatal hernia repair combined with gastroesophageal fixation can effectively alleviate reflux symptoms in SG patients with coexisting hiatal hernia, demonstrating favorable short-term efficacy and high safety. This approach may be a preferable surgical option for selected patients.