肥胖是食管裂孔疝（HH）的重要独立危险因素，显著增加HH的患病率。近年来，随着减重手术量的增加，术中合并HH的处理成为临床关注焦点。袖状胃切除术作为主流减重术式，术中联合HH修补术已成为治疗肥胖合并HH的重要策略。腹腔镜袖状胃切除术（LSG）联合HH修补术广泛应用，能有效减重、抗反流并减少术后胃食管反流病（GERD）的发生。Roux-en-Y胃旁路术联合HH修补术在减重与GERD改善方面效果更优，但手术难度较高。此外，新型术式如LSG联合保留膈食管前韧带的HH修补术也显示出良好的抗反流效果，但长期疗效尚待验证。综上所述，外科治疗肥胖合并HH应个体化选择术式，以实现最佳疗效。

Obesity is a significant independent risk factor for hiatal hernia (HH), markedly increasing its prevalence. In recent years, with the rising volume of bariatric surgeries, the management of concomitant HH during these procedures has become a key clinical focus. Sleeve gastrectomy, as a mainstream bariatric procedure, combined concurrently with hiatal hernia repair (HHR), has emerged as an important strategy for treating obesity complicated with HH. Laparoscopic sleeve gastrectomy (LSG) combined with HHR is widely used and can effectively promote weight loss, provide anti-reflux benefits, and reduce the incidence of postoperative gastroesophageal reflux disease (GERD). Roux-en-Y gastric bypass combined with HHR demonstrates superior outcomes in weight reduction and GERD improvement, albeit with higher technical difficulty. Furthermore, novel techniques such as LSG combined with HHR with preservation of the anterior phrenoesophageal ligament have shown promising anti-reflux effects, although their long-term efficacy requires further validation. In conclusion, the surgical treatment of obesity with HH should involve an individualized selection of the surgical approach to achieve optimal therapeutic results.