Quality of Life Outcomes After Fundoplication-Augmented One-Anastomosis Gastric Bypass: A Randomized Comparative Study

TL;DR

Adding fundoplication to gastric bypass surgery improves quality of life for obese patients with GERD by better controlling reflux symptoms.

Contribution

This study is the first to show that combining fundoplication with OAGB improves GERD-related quality of life and reduces PPI use in obese patients.

Findings

Fundoplication improved symptom control and reduced PPI use compared to OAGB alone.

GERD-HRQL scores improved significantly after fundoplication and remained better for 24 months.

Endoscopic and manometric evaluations confirmed effective reflux control with fundoplication.

Abstract

Background

Gastroesophageal reflux disease (GERD) frequently persists despite weight reduction, thereby diminishing anticipated improvements in quality of life following bariatric surgery. While one-anastomosis gastric bypass (OAGB) is metabolically effective, it may not completely manage reflux symptoms. This study assessed whether the incorporation of a modified fundoplication could enhance symptom control and health-related quality of life (HRQoL) compared with OAGB alone.

Methods

A prospective randomized comparative study was conducted involving 60 patients diagnosed with obesity and GERD. Participants were randomly allocated into two groups for a follow-up period of two years: Group A underwent OAGB only, and Group B received OAGB with modified fundoplication. Outcomes were evaluated based on preoperative and postoperative upper GI and manometry findings, as well as postoperative GERD-Health-Related Quality of Life (GERD-HRQL) scores.

Results

In comparison to OAGB alone, fundoplication demonstrated superior symptom control (Visick 2.10 ± 0.71 vs. 3.57 ± 0.73; p = 0.001) and resulted in a shorter duration of PPI use (2.43 ± 0.62 vs. 3.13 ± 0.68 months; p = 0.001). The GERD-HRQL scores showed significant improvement following fundoplication at six months (48.33 ± 7.91 to 31.57 ± 3.90; p < 0.001), and this improvement was sustained up to 24 months, whereas the changes observed after OAGB alone were not statistically significant. At the 24-month mark, endoscopic evaluation revealed an intact wrap with no evidence of GERD, and manometry confirmed restoration of LES function.

Conclusions

Compared with OAGB alone, the combination of OAGB with modified fundoplication offers a distinct advantage in terms of quality of life, as evidenced by improved symptom scores, decreased reliance on proton pump inhibitors, and enhanced endoscopic and manometric control of reflux. This integrated approach represents a viable strategy for optimizing the HRQoL of patients with obesity and GERD. However, validation through larger multicenter studies with extended follow-up periods and pH impedance monitoring is necessary.