Perioperative morbidity and midterm outcomes following antireflux surgery in overweight and obese populations

Why clinicians should know about it

• Picked for Endocrinology, Diabetes and Metabolism (paper of the day, 8 August 2026).

Abstract

BACKGROUND: As the worldwide prevalence of obesity increases, more patients with obesity are referred for antireflux surgery (ARS). Although bariatric surgery is typically recommended, at times straightforward ARS is offered. We aimed to compare surgical and patient-reported outcomes among overweight and obese patients undergoing minimally invasive ARS. METHODS: This retrospective cohort study included consecutive patients with BMI ≥ 25 kg/m2 who underwent primary elective ARS by an experienced foregut surgeon (September 2016-June 2025). Patients were stratified by BMI: overweight 25-30, class I obesity 30-35, class II obesity 35-40, and class III obesity ≥ 40 kg/m2. Exclusions included prior foregut procedures or non-fundoplication ARS (e.g., magnetic sphincter augmentation). Outcomes of interest were perioperative morbidity, hernia recurrence, midterm quality-of-life scores, and patient satisfaction. RESULTS: A total of 338 patients (71.6% female; median age: 65.1 [54.6-73.1] years) were stratified into the BMI groups: overweight (n = 172, 50.9%), class I (n = 125, 36.9%), class II (n = 30, 8.9%), and class III (n = 11, 3.3%). Intraoperative complication rates (3.5, 4.8, 3.3, and 27.3%; p = 0.006) and ICU admission rates (1.7, 4, 3.3, and 18.2%; p < 0.026) were significantly higher, and early postoperative complications were slightly higher (7.6, 8.8, 6.7, and 27.3%; p = 0.153) in the class III obesity group. Follow-up ≥ 12 months was available for 95/172 (55.2%), 64/125 (51.2%), 15/30 (50%), and 3/11 (27.3%) patients per group with similar median durations (24-36 months). Objective hiatal hernia recurrence (> 2 cm) was observed in 1 overweight and 2 class-I patients, but no class-II/III patients. Improved quality-of-life (GERD-HRQL) scores and high patient satisfaction, especially in the 25-40 kg/m2 BMI groups, were reported. CONCLUSION: Minimally invasive ARS provides a favorable safety profile along with gastroesophageal reflux control and improved quality of life for overweight and non-morbidly obese patients. Particularly, straightforward ARS for patients with class II obesity may be considered when limitations on bariatric surgery exist.

Abstract as published, via PubMed.