Antireflux surgery holds up in severe obesity

In 2,388 patients undergoing fundoplication or magnetic sphincter augmentation for reflux disease, body mass index of 35 or higher did not worsen symptom relief, medication independence, or five-year durability.

• Obese patients had larger hiatal hernias and more severe reflux before surgery.
• At 1 year, satisfaction was 81.6% versus 83.3%, and proton-pump inhibitor independence was 85.1% versus 85.5%; results remained similar at 3 years.
• Five-year anatomic integrity and revision rates were also comparable: 75.8% versus 78.2% and 4.5% versus 5.3%.

For magnetic sphincter augmentation, acid exposure normalized less often in obese patients (48.1% versus 71.0%). Body mass index alone should not exclude patients from antireflux surgery.