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Magnetic sphincter augmentation with hiatal hernia repair: long term outcomes

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Abstract

Introduction

Magnetic sphincter augmentation (MSA) is a safe and effective treatment for patients with gastroesophageal reflux disease (GERD). MSA was initially indicated for patients with GERD and concomitant hiatal hernias < 3 cm. However, excellent short- and intermediate-term outcomes following MSA and hiatal hernia repair in patients with hiatal hernias ≥ 3 cm have been reported. The purpose of this study is to assess long-term outcomes for this patient population.

Methods and procedures

A retrospective review was performed of patients with GERD and hiatal hernias ≥ 3 cm who underwent MSA and hiatal hernia repair. Patients were treated at two tertiary medical centers between May 2009 and December 2016. Follow up included annual video esophagram, upper endoscopy, or both. Outcomes included pre- and post-operative GERD health-related quality of life (GERD-HRQL) scores, length and regression of Barrett’s esophagus, resolution of esophagitis, need for endoscopic dilations or implant removal, and clinically significant hiatal hernia recurrence (> 2 cm) on videoesophagram or endoscopy.

Results

Seventy-nine patients (53% female) with a median age of 65.56 (58.42–69.80) years were included. Median follow up was 2.98 (interquartile range 1.90–3.32) years. Median DeMeester scores decreased from 42.45 (29.12–60.73) to 9.10 (3.05–24.30) (p < 0.001). Severity of esophagitis (e.g. LA class C to class B) significantly improved (p < 0.01). Forty percent of patients with Barrett's esophagus experienced regression (p < 0.01). Median GERD-HRQL scores improved from 21 to 2. Five (6.3%) hiatal hernia recurrences occurred, and 1 required re-operation. Age, body mass index, size of the initial hiatal hernia, and sex had no significant effect on whether a patient developed a recurrence.

Conclusions

Magnetic sphincter augmentation in conjunction with large hiatal hernia repairs for patients with GERD achieves excellent long-term radiographic and clinical results, and a low overall need for reoperation, without the need for mesh.

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Funding

None received for this study.

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Authors and Affiliations

  1. The Division of Upper GI and General Surgery at the University of Southern California, Los Angeles, CA, USA

    Colin P. Dunn, Jasmine Zhao, Jennifer C. Wang, Tanu A. Patel, Luke R. Putnam, Aleeson Eka, Caitlin C. Houghton, Nikolai A. Bildzukewicz & John C. Lipham

  2. Hoag Memorial Hospital Presbyterian Digestive Health Institute, Newport Beach, CA, USA

    Colin P. Dunn, Luke R. Putnam, Caitlin C. Houghton, Nikolai A. Bildzukewicz & John C. Lipham

  3. Keck Medical Center of USC, University of Southern California, 1510 San Pablo St #514, Los Angeles, CA, 90033, USA

    Luke R. Putnam, Caitlin C. Houghton, Nikolai A. Bildzukewicz & John C. Lipham

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  1. Colin P. Dunn
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Correspondence to John C. Lipham.

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Disclosures

Drs. Lipham and Bildzukewicz are consultants for Ethicon which manufactures the LINX® device. Colin Dunn, Luke Putnam, Aleeson Eka, Jasmine Zhao, Tanu Patel, Jennifer Wang and Caitlin Houghton have no conflicts of interest to disclose.

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Dunn, C.P., Zhao, J., Wang, J.C. et al. Magnetic sphincter augmentation with hiatal hernia repair: long term outcomes. Surg Endosc 35, 5607–5612 (2021). https://doi.org/10.1007/s00464-020-08063-9

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  • DOI: https://doi.org/10.1007/s00464-020-08063-9

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