Antireflux Surgery in Patients with Moderate Obesity - Fundoplication or Roux-en-Y Gastric Bypass?

Background: Gastroesophageal reflux disease (GERD), often associated with obesity, impairs quality of life and can lead to complications. This study compared Fundoplication and Roux-en-Y Gastric Bypass (RYGB) in patients with WHO (World Health Organization) class I and II obesity and refractory GERD.

Material and methods: A single-center, retrospective study analyzed 93 patients (55 Fundoplication, 38 RYGB) with BMI < 40 kg/m² who underwent surgery between January 2018 and September 2021. Preoperative characteristics, surgical outcomes, and postoperative results after three months and after one year were analyzed. Quality of life was assessed using Bariatric Quality of Life (BQL) and Quality of Life in Reflux and Dispepsia (QOLRAD) questionnaires. Propensity-score matching (PSM) was performed using the parameters age, BMI and gender.

Results: Patients who underwent RYGB had higher preoperative BMI (35.9 vs. 27.5 kg/m², p < 0.0001) and more metabolic comorbidities. Patients who underwent Fundoplication experienced longer anesthesia (192.5 vs. 112 min, p < 0.0001), operation times (134 vs. 79 min, p < 0.0001), and hospital stays (4 vs. 3 days, p = 0.0003). Complication rates in general (p = 0.0154, after three months) and dysphagia rates in particular (p = 0.0036, after three months and p = 0.0147, after one year) were higher in the Fundoplication group. Preoperatively, patients undergoing RYGB reported poorer quality of life in BQL questionnaires (p = 0.0008). PSM showed less reflux regression in the Fundoplication group after three months (p = 0.0223).

Conclusion: Despite higher preoperative BMI and comorbidities, patients undergoing RYGB had shorter operative times and hospital stays. The results suggest RYGB may be preferable for patients with refractory GERD and class I and II obesity, but further research on long-term outcomes is needed.