Obesity and Antireflux Surgery: BMI ≥35 Alone Should Not Exclude Surgery: Annals of Surgery | September 2026
What Did the Study Find?
This study evaluated 2,388 patients undergoing primary fundoplication or magnetic sphincter augmentation (MSA), including 309 with BMI ≥35 kg/m².
- Patients with obesity presented with larger hiatal hernias and greater baseline acid exposure.
- At 1 year, GERD-related quality of life improved similarly regardless of BMI.
- PPI independence was nearly identical: 85.1% vs 85.5%.
- Patient satisfaction was also comparable (81.6% vs 83.3%).
- Clinical outcomes remained similar at 3 years.
- At 5 years, anatomic integrity was comparable (75.8% vs 78.2%).
- Revisional surgery rates were also similar (4.5% vs 5.3%).
- One important exception emerged with MSA: pH normalisation was lower in patients with obesity (48.1% vs 71.0%).
Why Does It Matter?
Obesity has traditionally raised concern about antireflux surgery because increased intra-abdominal pressure could theoretically compromise long-term repair durability, with some guidelines favouring Roux-en-Y gastric bypass.
GastroAGI Takeaway
BMI ≥35 kg/m² alone should not automatically exclude a patient from antireflux surgery. Despite more severe baseline reflux, obese patients achieved similar symptom control, PPI independence, satisfaction and 5-year anatomical durability. The important caution is MSA, where objective acid normalisation was substantially lower—highlighting the need to distinguish symptomatic success from physiological reflux control when selecting the procedure.
