Surgical Management of GERD in Moderate Obesity: Fundoplication vs RYGB

Overview

This retrospective study compares Fundoplication and Roux-en-Y Gastric Bypass (RYGB) in patients with GERD and moderate obesity (BMI < 40 kg/m2). It evaluates perioperative complications, reflux control, quality of life, and comorbidity reduction, providing data to guide surgical decision-making in this population.

Background

GERD is a chronic condition characterized by reflux of stomach contents causing symptoms and complications such as esophagitis and Barrett's esophagus. Obesity worsens GERD by increasing intraabdominal pressure, complicating management. Fundoplication enhances the esophageal barrier to reflux, while RYGB induces weight loss and alters gastric anatomy to reduce acid and bile reflux. Although RYGB is preferred in severe obesity, optimal surgical choice in moderate obesity remains unclear due to limited comparative data.

Data Highlights

Key Findings

• RYGB provides superior control of GERD symptoms in patients with moderate obesity compared to Fundoplication.
• RYGB results in greater weight loss and improvement of obesity-related comorbidities such as diabetes, hypertension, and hypercholesterolemia.
• Fundoplication is associated with satisfactory reflux control but less impact on weight and metabolic syndrome.
• Perioperative morbidity is lower with RYGB in patients with severe obesity; this study evaluates if similar trends exist in moderate obesity.
• Quality of life related to reflux and obesity improves after both surgeries but may be more pronounced after RYGB.
• Propensity score matching was used to balance age, BMI, and gender between groups for valid comparison.

Clinical Implications

In patients with GERD and moderate obesity, RYGB should be considered especially when weight loss and metabolic improvement are desired alongside reflux control. Fundoplication remains a viable option for patients prioritizing reflux symptom relief without the need for significant weight reduction. Surgical choice should be individualized based on patient comorbidities, symptom severity, and preferences.

Conclusion

This study provides important comparative data supporting the use of RYGB over Fundoplication in managing GERD in moderately obese patients, highlighting benefits in reflux control and comorbidity improvement. Further prospective trials are needed to establish definitive guidelines.

References

1. General GERD and obesity pathophysiology [1-4]
2. Fundoplication efficacy [5]
3. RYGB mechanisms and benefits [6,7]
4. RYGB vs Fundoplication in severe obesity [8-10]
5. Surgical decision factors in moderate obesity [11-13]
6. RSI questionnaire for reflux symptoms [14]
7. BQL questionnaire for obesity-related quality of life [15]
8. QOLRAD questionnaire for reflux-related quality of life [16,17]