Abstract
Background:
Severe obesity is associated with an increased prevalence of hiatal hernias (HH) and gastroesophageal reflux disease (GERD). Both fundoplication (FP) and gastric bypass (GB) are utilized in this population, but comparative outcomes are not well-established. This review aims to compare surgical outcomes of FP versus GB for managing GERD and HH in adults with severe obesity.
Methods:
A systematic search was conducted for studies published up to June 2025. Inclusion criteria: adult patients with obesity (BMI ≥ 30) with HH/GERD undergoing first FP or GB. Key outcomes were postoperative reflux, complications, recurrence, and reoperation.
Results:
Five studies met inclusion criteria. Both FP and GB effectively manage GERD. In a propensity-matched cohort, GB significantly reduced early hernia recurrences compared to FP, but long-term recurrence and reoperation rates were similar between groups. Another study found similar recurrence rates between GB and FP; however, fewer symptomatic recurrences occurred with GB. A large retrospective study reported a lower complication rate for GB versus FP (7% vs. 10%, p < 0.05) and no significant differences in reflux scores.
Conclusions:
Both FP and GB offer benefits in managing GERD and HH in patients with severe obesity. Future research should focus on comparing efficacy, standardizing outcome measures, and evaluating patient-centered outcomes.
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