Background and Objectives: Obesity and gastroesophageal reflux disease (GERD) are steadily increasing world weight and antireflux surgery must be performed simultaneously with bariatric surgery in obese patients. The purpose of this study is to compare bariatric and antireflux results after OAGB with different methods of fundoplication using the excluded stomach and without fundoplication. Materials and methods: This open-label, randomized, parallel three-arm trial was conducted from March 2019 and December 2021. All patients underwent laparoscopic one-anastomosis gastric bypass and suture cruroplasty, and then had a follow-up at 24 months. Group 1 of patients had fundoplication FundoRing using the excluded stomach (FundoRingOAGB); Group 2, with Nissen fundoplication using the excluded stomach (NissenOAGB); and Group 3, without fundoplication (OAGB). We studied changes in BMI, GERD symptoms (GERD-HRQL), and the VISICK score. Results: Of 219 participants screened, 150 were randomly allocated to 3 groups: FundoRingOAGB group (n = 50), NissenOAGB group (n = 50), and OAGB group (n = 50). At post-treatment month 24, BMI changes were as follows: from 40.7 ± 5.9 (31–53) to 24.3 ± 2.8 (19–29) kg/m² in FundoRingOAGB group; from 39.9 ± 5.3 (32–54) to 26.3 ± 2.9 (23–32) kg/m² in Nissen group; and from 40.9 ± 6.2 (32–56) to 28.5 ± 3.9 (25–34) kg/m² in OAGB group. The mean pre-operative GERD-HRQL heartburn score improved post-op in FundoRingOAGB group from 20.6 ± 2.24 (19.96, 21.23) to 0.44 ± 0.73 (0.23, 0,64); in NissenOAGB group from 21.34 ± 2.43 (20.64, 22.03) to 1.14 ± 1.4 (0.74, 1.53); and in OAGB group 20.5 ± 2.17 (19.9, 21.25) to 2.12 ± 1.36 (1.73, 2.5). GERD-HRQL total scores were from pre-op 25.2 ± 2.7 (24.4, 25.9) to 4.34 ± 1.3 (3.96, 4.7) post-op in FundoRingOAGB group; 24.8 ± 2.93 (24, 25.67) pre-op to 5.42 ± 1.7 (4.9, 5.9) in the NissenOAGB group; and from 21.46 ± 2.7 (20.7, 22.2) to 7.44 ± 2.7 (6.6, 8.2) in the OAGB group. The mean VISICK score improved from 3.64 ± 0.94 (3.7, 3.9) to 1.48 ± 1.26 (1.12, 1.84) in FundoRingOAGB, from 3.42 ± 0.97 (3.1, 3,7) to 2.5 ± 1.46 (2.06, 2.9) in NissenOAGB group and from 3.38 ± 0.88 (3.1, 3,69) to 2.96 ± 1.19 (2.62, 3.2) in OAGB group. Conclusions: Antireflux and bariatric results of FundoRingOAGB are better than using the NissenOAGB method and significantly better than OAGB without the use of fundoplication.

The highly effective one-anastomosis gastric bypass (OAGB) is one of the most widely performed procedures in bariatric/metabolic surgery. However, concerns

Objective: To compare the 3-year quality of life, weight loss, comorbidity remission, and complication rates between FundoRing One-Anastomosis Gastric Bypass (f-OAGB) and standard OAGB (s-OAGB) in patients with obesity. Background: While OAGB is an effective metabolic procedure, it is associated with specific complications like bile reflux and marginal ulcers. The FundoRing modification, involving total fundoplication of the excluded stomach, may mitigate these risks. Long-term, patient-centered outcomes measured by the Bariatric Analysis and Reporting Outcome System (BAROS) are crucial. Methods: In this single-center, prospective randomized trial, 1000 patients (BMI 30-50 kg/m²) were assigned 1:1 to f-OAGB (n=500) or s-OAGB (n=500) between January 2021 and December 2024. A detailed CONSORT flow diagram guided the study. Randomization was performed by a statistician using sequentially numbered opaque envelopes. Outcome assessors were blinded. The primary outcome was the total BAROS score at 3 years. Safety was assessed using structured criteria, including 30-day and late complications (Clavien-Dindo classification). Results: At 3 years, follow-up was 83.0% (415/500) for f-OAGB and 87.0% (435/500) for s-OAGB (reasons for attrition: lost to follow-up, protocol violations, withdrawal of consent). The f-OAGB group demonstrated a significantly higher total BAROS score (5.59±1.13 vs. 4.57±1.09; mean difference 1.02, 95% CI 0.87–1.17; p<0.001), indicating a "very good" vs. "good" outcome. f-OAGB resulted in superior %EWL (84.3±12.1% vs. 76.8±14.3%; p<0.001), greater improvement in medical conditions, and better quality of life. No intraoperative, 30-day, or late mortality occurred in either group during the 3-year follow-up period (overall mortality 0%). f-OAGB was associated with significantly lower rates of bile reflux (0.2% vs. 9.4% at 3 years, p<0.001), marginal ulcers (0.2% vs. 3.4% at 3 years, p<0.001), and dumping syndrome (13.7% vs. 36.5% at 3 years, p<0.001). Conclusions: At 3 years post-surgery, FundoRing OAGB is superior to standard OAGB in achieving better overall health outcomes as measured by the BAROS score. It provides enhanced weight loss, greater comorbidity resolution, and superior quality of life, while significantly reducing the risk of bile reflux, marginal ulceration, and dumping syndrome. F-OAGB represents a safe and effective technical advancement in metabolic surgery.

Outpatient surgery means that the patient patient has surgery and often goes home on the same day. Safety and utilization outcomes were similar between out