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Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias

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Abstract

Background

Magnetic sphincter augmentation (MSA) has demonstrated long-term safety and efficacy in the treatment of patients with gastroesophageal reflux (GERD), but its efficacy in patients with large hiatal hernias has yet to be proven. The aim of our study was to assess outcomes of MSA in patients with hiatal hernias ≥3 cm.

Methods

We retrospectively reviewed all patients who underwent MSA at our institutions over a 6-year period. Information obtained consisted of patient demographics, symptoms of GERD, preoperative GERD Health-Related Quality-of-Life (HRQL) scores, perioperative details, and implantation of the MSA device. Primary endpoints included postoperative GERD-HRQL scores, proton-pump inhibitor (PPI) use, symptom change, and procedure-related complications. A large hiatal hernia was defined as a hernia measuring ≥3 cm by intraoperative measurement.

Results

A total of 192 patients were reviewed. Median follow-up was 20 months (3–75 months). Mean GERD-HRQL scores in the overall population before and after MSA were 18.9 and 5.0, respectively (p < 0.001). In the majority of patients symptoms improved or resolved (N = 177, p < 0.001). Fifty-two patients (27.0 %) had a hiatal hernia ≥3 cm (range 3–7 cm). Their mean GERD-HRQL score decreased from 20.5 to 3.6 (p < 0.001) following MSA. When compared to patients with smaller hernias, patients with large hiatal hernias had decreased postoperative PPI requirement (9.6 vs. 26.6 %, p = 0.011) and lower mean postoperative GERD-HRQL scores (3.6 vs. 5.6, p = 0.027). The percent of patients requiring postoperative intervention for dysphagia was similar (13.5 vs. 17.9 %, p = 0.522), as was the incidence of symptom resolution or improvement (98.1 vs. 91.3 %, p = 0.118).

Conclusion

MSA in patients with large hiatal hernias demonstrates decreased postoperative PPI requirement and mean GERD-HRQL scores compared to patients with smaller hernias. The incidence of symptom resolution or improvement and the percentage of patients requiring intervention for dysphagia are similar. Short-term outcomes of MSA are encouraging in patients with gastroesophageal reflux disease and large hiatal hernias.

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Authors and Affiliations

  1. Keck School of Medicine of USC, Los Angeles, CA, USA

    Kais A. Rona, Jessica Reynolds, Katrin Schwameis, Joerg Zehetner, Kamran Samakar, Paul Oh, David Vong, Kulmeet Sandhu, Namir Katkhouda, Nikolai Bildzukewicz & John C. Lipham

  2. Department of General Surgery, Keck Hospital of USC, 1510 San Pablo St., HCC Suite 514, Los Angeles, CA, 90033, USA

    Joerg Zehetner, Kamran Samakar, Kulmeet Sandhu, Namir Katkhouda, Nikolai Bildzukewicz & John C. Lipham

  3. James and Pamela Muzzy Endowed Chair in Gastrointestinal Cancer, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA

    John C. Lipham

Authors
  1. Kais A. Rona
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  2. Jessica Reynolds
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  3. Katrin Schwameis
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  6. Paul Oh
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  10. Nikolai Bildzukewicz
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  11. John C. Lipham
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Corresponding author

Correspondence to John C. Lipham.

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Disclosures

Dr. Lipham is a consultant for Torax® Medical, manufacturer of the LINX® reflux management system. Drs. Rona, Reynolds, Schwameis, Oh, Vong, Zehetner, Sandhu, Samakar, Katkhouda, and Bildzukewicz have no conflicts of interest or financial ties to disclose.

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Rona, K.A., Reynolds, J., Schwameis, K. et al. Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias. Surg Endosc 31, 2096–2102 (2017). https://doi.org/10.1007/s00464-016-5204-3

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  • DOI: https://doi.org/10.1007/s00464-016-5204-3

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