SAGES 2026 Annual Meeting Emerging Technology Session

INTRODUCTION

Gastroesophageal Reflux Disease (GERD) is one of the most common gastrointestinal issues
Complications of GERD include esophagitis, peptic strictures, Barrett's esophagus, and esophageal adenocarcinoma
Obesity (BMI ≥30 kg/m²) is a strong contributor to the development of GERD and GERD-Related Complications
GERD Treatments: Lifestyle modifications, proton pump inhibitors (PPIs), histamine blockers, surgery
Surgical Management: Nissen fundoplication, Partial Fundoplication (Toupet and Watson), LINX magnetic sphincter augmentation (MSA)
GOAL: To compare postoperative outcomes between obese and non-obese patients who underwent surgical management for GERD
GOAL: To identify if a particular type of anti-reflux surgery is more effective at symptom reduction for obese patients

METHODS AND PROCEDURES

Dual-center retrospective cohort study of 224 patients
Inclusion criteria: Patient ≥18 years of age who underwent anti-reflux surgery
Exclusion criteria: Patients without preoperative or postoperative survey data, had undergone previous anti-reflux surgery
Patients divided into two groups: obese (BMI ≥ 30kg/m2) and non-obese (BMI < 30kg/m2)
Data collected preoperatively and postoperatively using the Registry of Outcomes from Anti-Reflux Surgery (ROARS) questionnaire
Data was grouped as short-term (3-6 months), intermediate term (1-2 years), and long-term (3-5 years)
Outcomes assessed include dysphagia, regurgitation, and Health-Related Quality of Life (HRQL)

RESULTS

All Procedure Types (Figure 1a)

No significant differences in dysphagia or HRQL between obese and non-obese patients at short, intermediate, or long -term intervals
Significantly higher regurgitation scores in non-obese patients at intermediate follow-up that later resolved at long-term follow up

Partial Fundoplication (Figure 1b)

No differences between obese and non-obese patients at any postoperative time-point in any of the ROARS outcomes including dysphagia, regurgitation, and HRQL

LINX MSA (Figure 1c)

Non-obese patients had significantly higher regurgitation scores at intermediate follow-up that later resolved at long-term follow up
No significant differences in dysphagia or HRQL between obese and non-obese patients at short, intermediate, or long-term intervals

CONCLUSION

Obesity did not adversely impact long term postoperative outcomes of dysphagia, regurgitation, or HRQL following anti-reflux surgery across LINX®, Toupet and Watson partial fundoplication.
Both obese and non-obese patients reported comparable symptom scores at short, intermediate, and long-term follow-up, aside from increased HRQL scores in the non-obese patients who underwent LINX® that later resolved
No one particular fundoplication method was best for obese patients.
Further studies with larger and longer-term patient populations are warranted to confirm these results

Figure 1. Obese vs. Non-Obese Postoperative Outcomes

Comparison of mean ROARS scores for dysphagia, regurgitation, and health-related quality of life (HRQL) among non-obese (BMI < 30 kg/m²) and obese (BMI ≥ 30 kg/m²) patients who underwent (A) all procedure types (B) partial fundoplication (Toupet or Watson), (C) LINX magnetic sphincter augmentation. Significance is denoted by an asterisk. Nissen fundoplication was excluded from analysis due to small sample size

SAGES 2026 Annual Meeting Emerging Technology Session

COMPARING POSTOPERATIVE OUTCOMES OF ANTIREFLUX SURGERY BASED ON OBESITY STATUS

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