Patients with Obesity Undergoing Roux-En-Y Gastric Bypass Versus Fundoplication for Refractory GERD: A Systematic Review and Meta-Analysis
Abstract
Background Gastroesophageal reflux disease (GERD) significantly impairs quality of life and is associated with complications such as Barrett’s esophagus and esophageal adenocarcinoma. Obesity exacerbates GERD pathophysiology by elevating intra-abdominal pressure, making treatment more difficult. Current evidence suggests that Roux-en-Y gastric bypass (RYGB) offers superior outcomes compared to fundoplication in patients with severe obesity (BMI ≥ 40 kg/m²). This review aims to critically evaluate fundoplication versus RYGB in the population with obesity and GERD. Methods We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. We performed a comprehensive search across PubMed, Embase, and Cochrane databases for studies comparing fundoplication versus RYGB in patients with obesity and GERD. Data extraction was standardized, focusing on intraoperative complications, operative time, length of hospital stay, reoperation, postoperative complications, postoperative dysphagia, and DeMeester score. Statistical analysis was performed using Cochrane RevMan (Review Manager 9.7.1), employing random-effects models. Heterogeneity was assessed using Cochran’s Q test and I² statistic. Results The analysis included 7 observational studies. We found no differences in complication rates after sensitivity analysis. There were no differences in dysphagia, reoperation rate, operative time and length of stay. At a weighted mean follow-up of 42.3 months (range: 19.6…
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