Bariatric surgery in patients with gastroesophageal reflux disease and/or hiatus hernia.

INTRODUCTION Gastro-Oesophageal Reflux Disease (GORD) and Hiatus Hernia(HH) are frequently encountered comorbidities in patients seeking Bariatric and Metabolic Surgery (BMS) for obesity. Sleeve Gastrectomy (SG), Roux-en-Y Gastric Bypass (RYGB), and One Anastomosis Gastric Bypass (OAGB) are the three commonest bariatric procedures performed worldwide. The purpose of this review was to analyse and compare the data on outcomes of these three procedures in patients with GORD and/or HH. EVIDENCE ACQUISITION We examined published English language scientific literature available on PubMed for data comparing SG, RYGB, and OAGB with specific focus on GORD outcomes and outcomes in those with GORD and/or HH. EVIDENCE SYNTHESIS Several authors have addressed the outcome of GORD after bariatric surgery. There have been randomised control trials and comparative studies in the literature comparing the results of these procedure. But very few studies have exclusively looked into the outcome of different procedures in patients with pre-existing GORD and/or HH. In this narrative review, we evaluate pros and cons of three commonest bariatric procedures worldwide in this subgroup of patients seeking BMS. We also suggest an algorithm on the basis of our experience and the available data in scientific literature. CONCLUSIONS Though RYGB is the best anti reflux procedure it is associated with significant higher morbidity/mortality as compared to SG and OAGB. These two procedures can be used in the majority of patients with GORD and/or HH seeking BMS with an acceptance that some patients will need conversion to RYGB in the long term.