Background: Vertical gastrectomy or gastric sleeve has gained popularity among surgeons, due to its lower technical complexity and good results. However, there are conflicting results regarding the gastroesophageal reflux (GERD) after the sleeve. Several studies suggest an increase in the severity of reflux symptoms and "de novo" or a new appearance after surgery, among other reasons, due to a decrease in gastric emptying, an increase in intragastric pressure, a decrease in residual stomach distensibility and a weakening of the lower esophageal sphincter (IAS). On the other side, the hiatal hernia (HH) is closely related to the presence of GERD. Objective: To analyze the symptoms of GERD and use of anti-reflux medications in morbidly obese patients undergoing concomitant crural closure with laparoscopic sleeve gastrectomy for morbid obesity. Patients and methods: This prospective study was done in the surgery department, at Al-Azhar university hospitals in the period between October 2019 and October 2021. Thirty morbidly obese patients were included in this study. All patients were operated upon for laparoscopic sleeve gastrectomy, in patients with wide hiatal opening, simultaneous crural closure was done. Follow up of all patients for at least 6 months postoperative including history and endoscopy. Results: There were highly statistically significant reduction BMI (kg/m2) and weight (kg) in 6 months and 12 months compared to preoperative. There was statistically significant improved in hyperlipidemia in postoperative compared to preoperative with p-value (p<0.05), while it was improved in type 2 diabetes mellitus and hypertension but insignificant, with p-value (p>0.05). There was statistically significant decrease GERD in postoperative compared to preoperative, with p-value (p<0.05 S).      Regarding complications, intraoperative tear of the splenic capsule occurred with bleeding. This was controlled laparoscopically with argon laser. Regarding complications directly related to sleeve gasterectomy, there was no leaks, no strictures, no gastrointestinal bleeding, and no perioperative deaths. There were no conversions to an open procedure. Conclusion: Sleeve gastrectomy with concomitant crural repair and stitching of the crura of diaphragm is considered a feasible and safe technique providing good results in management of GERD symptoms for obese patients with reflux symptoms and hiatus hernia.