Objective:

To compare the safety and efficacy of Roux-en-Y gastric bypass (RYGB) and fundoplication as primary interventions for obese patients with gastroesophageal reflux disease (GERD), highlighting the significance of this comparison in managing obesity-related GERD.

Key Findings:

• RYGB offers superior reflux control compared to fundoplication in patients with severe obesity, which is crucial for long-term management.
• Higher recurrence rates of reflux were noted in obese patients undergoing fundoplication, indicating a need for careful patient selection.
• No significant differences in perioperative complications or return to daily activities between the two procedures.

Interpretation:

RYGB may be a more effective surgical option for obese patients with refractory GERD, particularly in those with severe obesity, compared to fundoplication, emphasizing the clinical relevance of these findings.

Limitations:

• Variability in study designs and populations included in the meta-analysis, which may affect the generalizability of the results.
• Potential biases in observational studies and reliance on administrative databases for some data, which could skew outcomes.

Conclusion:

RYGB is recommended as a preferable surgical intervention for obese patients with refractory GERD, providing better outcomes in reflux control compared to fundoplication, underscoring its importance in clinical practice.