• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Medically Refractory GERD in the Obese: Expert Opinion on the Best Surgical Approach

Medically Refractory GERD in the Obese: Expert Opinion on the Best Surgical Approach

Maurice Page, MD, Andrew Kastenmeier, MD, Matthew I Goldblatt, MD, Matthew Frelich, MS, Matthew Bosler, BA, James Wallace, MD, PhD, Jon C Gould, MD

Medical College of Wisconsin, Department of Surgery, Division of General Surgery

Introduction: The prevalence of both obesity and gastroesophageal reflux disease (GERD) has increased in recent decades. Obesity is a risk factor for GERD. In fact, GERD is considered a comorbid medical condition of obesity and has been demonstrated to respond to bariatric surgery. In both GERD and obesity, surgery is an effective treatment for severe and medically refractory patients. Traditional antireflux procedures (fundoplication) may be associated with a higher failure rate in obese patients. For many reasons, in morbidly obese patients with medically refractory GERD, surgeons and patients alike often opt for bariatric surgery with excellent outcomes. Unfortunately for some patients, their insurance companies decline to provide benefits for bariatric surgery for the indication of GERD – often stating that this is not within the standard of care. The aim of the current study was to characterize the expert opinions of minimally invasive surgeons who often deal with the surgical treatment of both diseases regarding this controversy.

Methods: A brief 13-item survey was designed to elicit professional opinions regarding the treatment of medically refractory GERD in obese patients. A total of 550 SAGES members were randomly selected and emailed a link to an online survey. Data was collected, stripped of all identifiers, and analyzed to characterize expert opinions on GERD and obesity.

Results: A total of 92 surgeons (17%) responded. Of the respondents, 88% perform laparoscopic fundoplication for GERD, 63% perform bariatric surgery, and 58.7% performs both. 77% completed a minimally invasive surgery fellowship. In response to the question “would you perform a laparoscopic fundoplication in a patient with medically refractory GERD and a BMI of ‘X’?” surgeons were less likely to offer fundoplication at a higher BMI (table).

30 kg/m2 35 kg/m2 40 kg/m2 45 kg/m2 50 kg/m2 55 kg/m2 >60 kg/m2
Yes 94.4% 57.8% 19.5% 11.1% 3.3% 2.3% 1.1%
No 5.6% 42.2% 80.5% 88.9% 96.7% 97.7% 98.9%

The majority of respondents felt that laparoscopic Roux-en Y gastric bypass was the best option to treat medically refractory GERD in morbidly obese patients (91%) followed by laparoscopic sleeve gastrectomy (6%). 57% of surgeons responding to the survey had a morbidly obese patient with a primary surgical indication of medically refractory GERD denied a bariatric procedure by their insurance company, and 35% of those surgeons chose to do nothing rather than subject the patient to a fundoplication. Nearly all surgeons to respond to this survey (96%) felt bariatric surgery should be recognized as a standard surgical option for treating medically refractory GERD in the obese.

Conclusions: When surgical treatment of GERD is indicated in a severely obese patient, bariatric surgery rather than fundoplication should be strongly considered, especially Roux-en Y gastric bypass. Unfortunately, third party payers often decline to provide benefits for what many experts agree is the best and most appropriate procedure. Additional data is necessary to confirm our belief that the opinions elicited through this survey represent the best practices and are consistent with the standard of care as defined by the medical community.


Session: Poster Presentation

Program Number: P235

209

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals