Surgery in the Morbidly Obese Patient with Gastroesophageal Reflux Disease (GERD)

Obesity rates have increased all over the world in the last three decades. Obesity and gastroesophageal reflux disease (GERD) are related. While a fundoplication is an excellent therapy in lean patients with GERD, outcomes may not be as good in morbidly obese patients. Therefore, bariatric surgery still remains the recommended treatment for GERD in this population. While all bariatric techniques may ameliorate GERD symptoms due to weight loss and a decrease in abdominal pressure, some operations like the sleeve gastrectomy may lead to a disruption of the antireflux mechanism and thus be a refluxogenic procedure. Conversely, the Roux-en-Y gastric bypass seems to be the appropriate option for patients who suffer from both diseases. Overall, understanding the pathophysiology of GERD in obese patients is essential for choosing the correct operation and achieving a successful outcome.