Gastroesophageal Reflux Disease Outcomes after Sleeve Gastrectomy with One Anastomosis Transit Bipartition: A Systematic Review and Meta-analysis.

BACKGROUND: Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure worldwide, but gastroesophageal reflux disease (GERD) remains a significant long-term complication affecting 20–35% of patients. Transit bipartition (TB) procedures have emerged as potential solutions for managing GERD while maintaining metabolic benefits. This systematic review evaluates GERD outcomes following TB procedures. METHODS: A systematic search of PubMed, Embase, Cochrane CENTRAL, and Web of Science was conducted through January 5, 2025, following PRISMA 2020 guidelines. Quality assessment used the MINORS instrument. Random-effects meta-analysis using Freeman-Tukey double arcsine transformation was performed in R (packages: meta 6.5-0, metafor 4.4-0). Heterogeneity was assessed using I², τ², and Cochran’s Q. Publication bias was evaluated using funnel plots and Egger’s test. RESULTS: Seven studies comprising 2,912 patients met inclusion criteria. The pooled GERD resolution rate was 88.4% (95% CI: 78.6–94.5%; I²=64.8%). De novo GERD occurred in 4.9% (95% CI: 2.8–7.8%). Leave-one-out sensitivity analysis demonstrated stable estimates (range: 85.7–89.2%). Publication bias assessment (Egger’s p = 0.089) with trim-and-fill adjustment suggested potential overestimation by approximately 4% points (adjusted estimate: 84.1%). CONCLUSIONS: Transit bipartition procedures demonstrate favorable short-term GERD outcomes with resolution exceeding 85% and low de novo GERD incidence below 5%. However, the evidence is limited by study design, heterogeneity, and short follow-up. These procedures offer effective weight loss with favorable GERD outcomes compared to standard sleeve gastrectomy.