Comparative Outcomes of Anti-Reflux Surgery in Obese Patients with Gastroesophageal Reflux Disease1

Introduction Roux-en-Y gastric bypass (RYGB) has been the preferred operation for obese patients with gastroesophageal reflux disease (GERD); however, some patients are hesitant to undergo bypass. Obese patients have a multifactorial predisposition to GERD, including lower esophageal sphincter (LES) dysfunction and aberrant pressure gradients across their diaphragmatic crura. Among non-obese patients, anti-reflux surgery (ARS) with hiatal hernia (HH) repair and LES augmentation has shown excellent long-term results. We aimed to determine whether patient satisfaction and GERD recurrence differed between obese and non-obese patients who underwent ARS. Methods Review of patients who underwent ARS between January 2012 and June 2021 was performed. Perioperative and postoperative characteristics were compared across three BMI groups: BMI < 30 kg/m(2), 30 kg/m(2) <= BMI < 35 kg/m(2), and BMI >= 35 kg/m(2). Results Four-hundred thirteen patients were identified, of which 294 (71.1%) had BMI < 30 kg/m(2), 87 (21.1%) were 30 kg/m(2) <= BMI < 35 kg/m(2), and 32 (7.7%) had a BMI >= 35 kg/m(2). Patients with BMI >= 35 kg/m(2) had higher preoperative manometric and EndoFLIP (TM) intra-balloon pressure at the LES than those with lower BMIs. This value was increased to a similar level throughout ARS across the three cohorts. Post-operative GERD-specific satisfaction was similar across the three cohorts, as were rates of postoperative reflux and hiatal hernia recurrence on barium swallow; rates of reoperation were low. Conclusions ARS with HH repair and LES augmentation may be appropriate for select patients across a range of BMIs, including those with a BMI >= 35 kg/m(2) who are hesitant to undergo RYGB.

Automated summary

Gastroesophageal reflux disease (GERD) is a common complication in obese patients. Roux-en-Y gastric bypass (RYGB) is the main treatment, but some patients are reluctant to undergo bypass. This study found that anti-reflux surgery (ARS) can achieve satisfactory results in patients with different body mass indexes (BMIs), including those with higher BMIs.