Patients with Obesity Undergoing Roux-En-Y Gastric Bypass Versus Fundoplication for Refractory GERD: A Systematic Review and Meta-Analysis

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. 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. 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 to 52.0) for fundoplication and 35.2 months (range: 14.6 to 49.0) for RYGB, GERD resolution, measured by the DeMeester score, slightly favored fundoplication, although the absolute difference was not clinically relevant. Regarding weight outcomes, RYGB demonstrated significantly higher total weight loss (TWL) at the 12-month follow-up. Fundoplication appears statistically superior for GERD resolution postoperatively, but the difference is not clinically relevant. RYGB has a higher TWL. Both procedures are safe for GERD control in patients with obesity. The choice between procedures should weigh reflux severity, complication risks, and metabolic diseases associated with obesity. Larger studies are needed to clarify the impact of surgical timing and patient-specific factors.