Abstract: Sleeve gastrectomy is currently the most commonly performed bariatric surgery procedure. There remains controversy regarding the intraoperative management of hiatal hernia during sleeve gastrectomy for obesity patients. In China, the mainstream approach is active explora-tion and repair of the hiatal hernia during surgery. Nevertheless, some reports suggest that this may not lead to definitive outcomes and might even exacerbate gastroesophageal reflux symptoms. Based on clinical experience, the authors discuss the current strategies of intraoperative management of hiatal hernia during sleeve gastrectomy, and explore the clinical management strategies for obesity patients with esophageal hiatal hernia undergoing sleeve gastrectomy.