The BARIREF Study: BARIatric Surgery Complications in Patients with Prior REFlux Surgery in a Large National Cohort.

Objective: To assess the outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in patients with prior fundoplication.

Background: Obesity and gastroesophageal reflux disease (GERD) often coexist, posing clinical challenges. Fundoplication is the standard treatment for GERD refractory to medical therapy. Managing obesity after fundoplication is complex and while RYGB is preferred for addressing both obesity and GERD, its use post-fundoplication requires further evaluation.

Methods: Retrospective analysis of a national French database of patients undergoing RYGB and SG between 2013 and 2023. Patients were grouped according to prior fundoplication (PriorF) or no fundoplication (NoF). Baseline demographics and 90-day postoperative outcomes were assessed. Univariate and multivariate analyses identified risk factors; 1:5 matching was applied based on sex, age, body mass index, comorbidities, surgery year, procedure type and center volume.

Results: Among 372,464 patients, 337 (0.1%) had prior fundoplication. PriorF patients had higher rates of severe postoperative complications (Dindo ≥IIIa: 8.9% vs. 3.7%, P < 0.001), longer hospital stays (4.5 ± 4.9 vs. 3.7 ± 2.9 d, P < 0.001), and higher readmission rates (17.8% vs. 10.6%, P < 0.001). Multivariate analysis for RYGB showed no significant association between prior fundoplication and complications (OR 1.71, 95% CI 1.00-2.74, P=0.051). Prior fundoplication was independently associated with increased complications after SG (OR 2.54, 95% CI 1.37-4.32, P < 0.001).

Conclusions: Prior fundoplication increased postoperative complications after SG but not after RYGB. RYGB appears to be the safer bariatric procedure in patients with prior fundoplication.