Does Treatment of the Hiatus Influence the Outcomes of Magnetic Sphincter Augmentation for Chronic GERD?
Publication Title
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
Document Type
Article
Publication Date
3-15-2019
Keywords
Antireflux surgery; Diaphragm; GERD; Hiatal hernia; Magnetic sphincter; Surgical outcomes
Abstract
BACKGROUND: Hiatal dissection, restoration of esophageal intra-abdominal length, and crural closure are key components of successful antireflux surgery. The necessity of addressing these components prior to magnetic sphincter augmentation (MSA) has been questioned. We aimed to compare outcomes of MSA between groups with differing hiatal dissection and closure.
METHODS: We retrospectively reviewed 259 patients who underwent MSA from 2009 to 2017. Patients were categorized based on hiatal treatment: minimal dissection (MD), crural closure (CC), formal crural repair (FC), and extensive dissection without closure (ED). The primary outcome was normalization of postoperative DeMeester score (≤ 14.72). Univariable and multivariable logistic regression was used to assess which preoperative predictors achieved normalization.
RESULTS: Of the 197 patients, MD was used in 81 (41%); FC in 42 (22%); CC in 40 (20%); and ED in 34 (17%). Normalization occurred in 104 (53%) patients, with MD achieving normalization in 45/81 (56%); FC in 25/42 (60%); CC in 21/40 (53%); and ED 13/34 (38%). After regression, FC was most likely to normalize acid exposure. The presence of a hiatal hernia, defective LES, and higher preoperative DeMeester score were less likely to achieve normalization.
CONCLUSIONS: Hiatal dissection with restoration of esophageal length and crural closure during MSA increases the likelihood of normalizing acid exposure.
Area of Special Interest
Cancer
Specialty/Research Institute
Oncology
Specialty/Research Institute
Swedish Thoracic Surgery
DOI
10.1007/s11605-019-04180-6
