OBJECTIVE: Laparoscopic sleeve gastrectomy (LSG) is effective for weight loss but may exacerbate gastroesophageal reflux disease (GERD) in predisposed patients. This randomized controlled trial aimed to evaluate whether adding cruroplasty to LSG (Cr-LSG) improves postoperative GERD symptom control in patients with intraoperative evidence of hiatal laxity. METHODS: A total of 100 patients undergoing LSG were randomized to either standard LSG or LSG with posterior cruroplasty (Cr-LSG). Patients with large hiatal hernias were excluded. GERD symptoms were assessed using the validated GERD-Health Related Quality of Life (GERD-HRQL) questionnaire at baseline, 3 months, and 6 months postoperatively. BMI changes were also recorded. Statistical analysis included mixed-design ANOVA for within- and between-group comparisons. RESULTS: Of the 100 enrolled patients, 95 (95%) completed the 6-month follow-up (LSG: 47, Cr-LSG: 48). Both groups demonstrated significant BMI reductions over time, with no between-group differences. GERD symptoms improved significantly within both groups postoperatively. However, between-group comparisons showed significantly lower GERD-HRQL scores in the Cr-LSG group at both 3 and 6 months (p < 0.05), suggesting better symptom control. Postoperative PPI use was not systematically recorded and represents a limitation. CONCLUSION: Adding cruroplasty to LSG may enhance short-term reflux symptom control in selected patients with intraoperative hiatal laxity. However, given the study's reliance on subjective symptom reporting and limited follow-up, these findings should be interpreted with caution. Further studies using objective diagnostics and longer-term follow-up are warranted.