Long-Term Outcomes of Magnetic Sphincter Augmentation: A Comparative Study to Nissen Fundoplication.

Publication Title

The Annals of thoracic surgery

Authors

Kelly E Daus, Division of Thoracic Surgery, Swedish Medical Center, Seattle, Washington.Follow
Alexander S Farivar, Division of Thoracic Surgery, Swedish Medical Center, Seattle, Washington.Follow
Adam J Bograd, Division of Thoracic Surgery, Swedish Medical Center, Seattle, Washington.Follow
Peter T White, Division of Thoracic Surgery, Swedish Medical Center, Seattle, WA, USAFollow
Ralph W Aye, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Brian Louie, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow

Document Type

Article

Publication Date

9-19-2024

Keywords

washington; swedish; swedish thoracic surgery

Abstract

BACKGROUND: Magnetic sphincter augmentation (MSA) demonstrates improvement in gastroesophageal reflux disease (GERD) across multiple short-term studies. Long-term, single-arm studies show durable outcomes, but there is limited comparative data to Nissen fundoplication (NF).

METHODS: We performed a retrospective propensity-matched cohort study of patients with GERD undergoing MSA or NF between 2012 and 2018. Patients were matched on age, sex, body mass index, size of hiatal hernia, length of Barrett esophagus, and motility in a 1:1 fashion. A total of 523 patients (177 MSA, 346 NF) underwent surgery and after matching 177 MSA and 177 NF cases were analyzed.

RESULTS: At 1 year, GERD quality of life scores improved (22 to 5 MSA vs 24 to 5 NF, P = .593). Proton pump inhibitor use was 14% vs 5% (P = .010). pH testing demonstrated improved DeMeester scores (42 to 21 vs 46 to 7, P < .001). At 5 years, GERD quality of life scores were stable (5 to 5 vs 5 to 4, P = .208). Proton pump inhibitor use was 31% vs 26% (P = .474). The incidence of endoscopic dilation was similar between MSA and NF (7% vs 10%, P = .347). Reoperation rates were higher for MSA (10% vs 4%, P = .022) and recurrent hiatal hernias were found in 18% vs 7% (P = .007). Compared to NF, MSA undergoing complete dissection showed no difference in dilation (5% MSA vs 7% NF, P = .527), reoperation (8% MSA vs 6% NF, P = .684) or hernia recurrence (10% MSA vs 6% NF, P = .432).

CONCLUSIONS: MSA achieves similar improvements in quality of life and freedom from medical therapy compared to NF, especially with complete hiatal repair.

Clinical Institute

Digestive Health

Specialty/Research Institute

Gastroenterology

Specialty/Research Institute

Surgery

Specialty/Research Institute

Swedish Thoracic Surgery

DOI

10.1016/j.athoracsur.2024.09.010