Laparoscopic Sleeve Gastrectomy Versus One-Anastomosis Gastric Bypass and the Risk of De Novo or Persistent Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

Background/Objectives: Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure worldwide; one-anastomosis gastric bypass (OAGB) ranks third. Gastroesophageal reflux disease (GERD) may develop de novo or worsen following either procedure. This systematic review and meta-analysis aimed to compare postoperative GERD outcomes—overall, de novo, and persistent—between LSG and OAGB. Methods: A PRISMA-compliant systematic review and meta-analysis were conducted. PubMed, Embase, the Cochrane Library, and Web of Science were searched for studies published between January 2000 and December 2025. A random-effects model was applied for the meta-analysis. Results: A total of 847 articles were identified. Among them, 15 primary studies met the inclusion criteria (four randomized controlled trials and 11 observational studies involving approximately 1800 LSG and 2450 OAGB patients). LSG was associated with a significantly higher risk of overall GERD (OR, 3.67; 95% CI, 2.54–5.30; p < 0.001; I2 = 55%), de novo GERD (OR, 4.12; 95% CI, 2.54–6.69; p < 0.001; I2 = 44%), and persistent or worsening GERD (OR, 2.67; 95% CI, 1.34–5.32; p = 0.005; I2 = 38%). Hiatal hernia was reported in only four studies; bile reflux was paradoxically higher after LSG than OAGB (74.7% vs. 12.5%). Conclusions: LSG carries significantly higher postoperative GERD risk than OAGB across all evaluated outcomes. Although Roux-en-Y gastric bypass remains the gold standard for bariatric patients requiring GERD control, OAGB represents a well-supported alternative that outperforms LSG in reflux-related outcomes and should be favored when GERD is a clinical concern.