Patients with Obesity Undergoing Roux-En-Y Gastric Bypass Versus Fundoplication for Refractory GERD: A Systematic Review and Meta-Analysis - Report - MDSpire
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Patients with Obesity Undergoing Roux-En-Y Gastric Bypass Versus Fundoplication for Refractory GERD: A Systematic Review and Meta-Analysis
Comparative Outcomes of RYGB vs Fundoplication in Obese Patients with Refractory GERD
Overview
This systematic review and meta-analysis compared Roux-en-Y gastric bypass (RYGB) and fundoplication in obese patients with refractory GERD. The analysis focused on GERD resolution, complication rates, and weight loss outcomes, highlighting RYGB's superior reflux control and weight loss benefits.
Background
GERD is common in obese individuals due to increased intra-abdominal pressure and other pathophysiological factors. While fundoplication has been the traditional surgical treatment for refractory GERD, its efficacy is limited in obese patients, especially those with severe obesity. RYGB is considered the gold standard for severe obesity and offers better reflux control by diverting gastric acid away from the esophagus. However, evidence comparing these two procedures in moderate obesity remains conflicting, necessitating a comprehensive evaluation.
Data Highlights
Outcome
Measure
Comparison
Result
GERD Resolution
Risk Ratio (RR)
RYGB vs Fundoplication
Higher resolution with RYGB
Complication Rates
RR
RYGB vs Fundoplication
No significant difference
Weight Loss
% Total Weight Loss (%TWL)
RYGB vs Fundoplication
Greater weight loss with RYGB
Reoperation Rates
RR
RYGB vs Fundoplication
Comparable between groups
Length of Stay & Operative Time
Mean Difference (MD)
RYGB vs Fundoplication
Data varied, no consistent significant difference
Key Findings
RYGB provides superior GERD resolution compared to fundoplication in obese patients.
Complication rates, including intraoperative and postoperative events, are similar between RYGB and fundoplication.
RYGB results in significantly greater total weight loss than fundoplication.
Reoperation rates do not differ significantly between the two surgical approaches.
Length of hospital stay and operative time show no consistent significant differences across studies.
Sensitivity analyses excluding specific populations (large hernias, Barrett’s esophagus) and administrative data confirm the robustness of primary outcomes.
Clinical Implications
For obese patients with refractory GERD, especially those with moderate to severe obesity, RYGB should be considered the preferred surgical intervention due to its superior reflux control and weight loss benefits. Fundoplication remains an option but may be associated with higher reflux recurrence. Clinicians should weigh individual patient factors and surgical risks when selecting the optimal procedure.
Conclusion
This meta-analysis supports RYGB as a more effective surgical treatment than fundoplication for GERD resolution and weight loss in obese patients, with comparable safety profiles. These findings can guide surgical decision-making in managing refractory GERD within this population.
References
Systematic Review and Meta-Analysis (2025) -- Comparative Outcomes of Roux-En-Y Gastric Bypass and Fundoplication in Obese Patients with Refractory GERD
