Purpose: Persistent, worse, or new symptoms of gastroesophageal reflux disease (GORD) are common after sleeve gastrectomy (SG) and can be associated with the presence of a hiatus hernia (HH). We aimed to assess the effectiveness of HH repair (HHR) for the management of medically refractory GORD symptoms after SG. Methods: We conducted a retrospective case series on patients from two centres who underwent HHR as an independent operation after SG. The primary outcome was GORD symptom severity measured using a structured symptom questionnaire (SSQ, total range 0-7). Secondary outcomes included changes in weight and obesity-related health problems and the need for further GORD treatment. Results: Fifty patients were included; mean age was 51 years, 80% were female and mean follow-up was 83.4 months. Patients demonstrated a significant reduction in body mass index (BMI) post-SG (mean reduction: 11.4 kg/m2, sd 5.81, p<0.0001). After SG, patients reported moderate-to-severe heartburn (84%, n=42), regurgitation (64%, n=32), and nocturnal reflux (48%, n=24). Following HHR, these symptoms significantly improved, with 90% (n=45) reporting mild or no heartburn, 84% (n=42%) experiencing mild or no regurgitation, and 88% (n=44) free of nocturnal reflux (p<0.0001 for all). There were no significant differences in reported outcomes for heartburn (p=0.28) or total reflux score (p=0.82) following hiatus hernia repair compared to pre-LSG scores. Six patients (12%) required conversion to Roux-en-Y gastric bypass (RYGB) due to recurrent GORD symptoms. Conclusion: HH repair presents a promising solution to adequately control GORD symptoms after SG. Severe reflux persists in a minority of patients who are unable to avoid conversion to RYGB.