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Impact of Obesity on Clinical, Physiologic, and Durability Outcomes After Antireflux Surgery in a 2,388-Patient Cohort
Journal article   Open access   Peer reviewed

Impact of Obesity on Clinical, Physiologic, and Durability Outcomes After Antireflux Surgery in a 2,388-Patient Cohort

Shahin Ayazi, Sven Eriksson, Ping Zheng, Vineeth Sadda, Michelle Bojalad, Ahmed Aly and David L Bartlett
Annals of surgery, Forthcoming
18 Jun 2026
DOI: https://doi.org/10.1097/SLA.0000000000007126
PMID: 42307085
url
https://doi.org/10.1097/SLA.0000000000007126View
Published, Version of Record (VoR) Open

Abstract

GERD magnetic sphincter augmentation antireflux surgery fundoplication outcomes Obesity
To evaluate the effect of obesity on subjective and objective outcomes after antireflux surgery (ARS). Obesity has traditionally been viewed as a relative contraindication to ARS with some guidelines favoring Roux-en-Y gastric bypass in this population. The concern that increased intra-abdominal pressure may compromise durability is physiologically plausible, but supporting clinical evidence is limited. Consecutive patients undergoing primary fundoplication or magnetic sphincter augmentation (MSA) between 2011 and 2024 were analyzed. Patients were stratified by body mass index (BMI) <35 kg/m² or ≥35 kg/m² (obese). Preoperative characteristics and postoperative outcomes were compared, including symptom control, objective reflux parameters, and anatomic integrity. A total of 2,388 patients were included, of whom 309 (12.9%) had BMI ≥35. Obese patients had larger hiatal hernias (P<0.001) and higher DeMeester scores [48.7 (34.8) vs. 44.1 (35.0), P=0.030]. At 1 year after surgery, GERD-HRQL scores improved in both groups and were comparable [10.7 (12.8) vs. 10.1 (13.0)], as were patient satisfaction (81.6% vs. 83.3%) and PPI independence (85.1% vs. 85.5%) (all P>0.05). These findings remained similar at 3 years. Five-year anatomic integrity (75.8% vs. 78.2%) and revisional surgery rates (4.5% vs. 5.3%) were similar between groups (all P>0.05). However, obese patients undergoing MSA had lower rates of pH normalization (48.1% vs. 71.0%, P=0.001). Patients with BMI ≥35 presented with more advanced reflux but achieved comparable symptom improvement, satisfaction, and PPI independence after ARS. Anatomic integrity and revision rates were similar, with reduced pH normalization observed only in the MSA subgroup. These findings support ARS in obese patients and suggest BMI alone should not determine surgical candidacy.

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