Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 10/2021

01-10-2021 | Esophagitis

Magnetic sphincter augmentation with hiatal hernia repair: long term outcomes

Authors: 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

Published in: Surgical Endoscopy | Issue 10/2021

Login to get access

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.

Graphic abstract

Literature
1.
Richter JE, Rubenstein JH (2018) Presentation and epidemiology of gastroesophageal reflux disease. Gastroenterology 154:267–276CrossRefPubMed
2.
Reynolds JL, Zehetner J, Bildzukewicz N, Katkhouda N, Dandekar G, Lipham JC (2014) Magnetic sphincter augmentation with the LINX device for gastroesophageal reflux disease after U.S. Food and Drug Administration approval. Am Surg 80:1034–1038CrossRefPubMed
3.
Hillman L, Yadlapati R, Thuluvath AJ, Berendsen MA, Pandolfino JE (2017) A review of medical therapy for proton pump inhibitor nonresponsive gastroesophageal reflux disease. Dis Esophagus 30:1–15PubMedPubMedCentral
4.
Azzam RS (2018) Are the persistent symptoms to proton pump inhibitor therapy due to refractory gastroesophageal reflux disease or to other disorders? Arq Gastroenterol 55(Suppl 1):85–91CrossRef
5.
Scarpellini E, Ang D, Pauwels A, De Santis A, Vanuytsel T, Tack J (2016) Management of refractory typical GERD symptoms. Nat Rev Gastroenterol Hepatol 13:281–294CrossRefPubMed
6.
Jaynes M, Kumar AB (2019) The risks of long-term use of proton pump inhibitors: a critical review. Ther Adv Drug Saf 10:2042098618809927CrossRefPubMed
7.
Reynolds JL, Zehetner J, Wu P, Shah S, Bildzukewicz N, Lipham JC (2015) Laparoscopic magnetic sphincter augmentation vs laparoscopic Nissen fundoplication: a matched-pair analysis of 100 patients. J Am Coll Surg 221:123–128CrossRefPubMed
8.
Reynolds JL, Zehetner J, Nieh A, Bildzukewicz N, Sandhu K, Katkhouda N, Lipham JC (2016) Charges, outcomes, and complications: a comparison of magnetic sphincter augmentation versus laparoscopic Nissen fundoplication for the treatment of GERD. Surg Endosc 30:3225–3230CrossRefPubMed
9.
Skubleny D, Switzer NJ, Dang J, Gill RS, Shi X, de Gara C, Birch DW, Wong C, Hutter MM, Karmali S (2017) LINX((R)) magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc 31:3078–3084CrossRefPubMed
10.
Ayazi S, Zaidi AH, Zheng P, Chovanec K, Chowdhury N, Salvitti M, Newhams K, Levy J, Hoppo T, Jobe BA (2019) Comparison of surgical payer costs and implication on the healthcare expenses between laparoscopic magnetic sphincter augmentation (MSA) and laparoscopic Nissen fundoplication (LNF) in a large healthcare system. Surg Endosc 34:2279–2286CrossRefPubMedPubMedCentral
11.
Pandolfino J, Lipham J, Chawla A, Ferko N, Hogan A, Qadeer RA (2019) A budget impact analysis of a magnetic sphincter augmentation device for the treatment of medication-refractory mechanical gastroesophageal reflux disease: a United States payer perspective. Surg Endosc 34:1561–1572CrossRefPubMed
12.
Czosnyka NM, Buckley FP, Doggett SL, Vassaur H, Connolly EE, Borgert AJ, Kallies KJ, Kothari SN (2017) Outcomes of magnetic sphincter augmentation—a community hospital perspective. Am J Surg 213:1019–1023CrossRefPubMed
13.
14.
Zhang H, Dong D, Liu Z, He S, Hu L, Lv Y (2016) Revaluation of the efficacy of magnetic sphincter augmentation for treating gastroesophageal reflux disease. Surg Endosc 30:3684–3690CrossRefPubMed
15.
Furnee EJ, Draaisma WA, Gooszen HG, Hazebroek EJ, Smout AJ, Broeders IA (2011) Tailored or routine addition of an antireflux fundoplication in laparoscopic large hiatal hernia repair: a comparative cohort study. World J Surg 35:78–84CrossRefPubMed
16.
Lidor AO, Steele KE, Stem M, Fleming RM, Schweitzer MA, Marohn MR (2015) Long-term quality of life and risk factors for recurrence after laparoscopic repair of paraesophageal hernia. JAMA Surg 150:424–431CrossRefPubMed
17.
Saino G, Bonavina L, Lipham JC, Dunn D, Ganz RA (2015) Magnetic sphincter augmentation for gastroesophageal reflux at 5 years: final results of a pilot study show long-term acid reduction and symptom improvement. J Laparoendosc Adv Surg Tech Part A 25:787–792CrossRef
18.
Rona KA, Reynolds J, Schwameis K, Zehetner J, Samakar K, Oh P, Vong D, Sandhu K, Katkhouda N, Bildzukewicz N, Lipham JC (2017) Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias. Surg Endosc 31:2096–2102CrossRefPubMed
19.
Rona KA, Tatum JM, Zehetner J, Schwameis K, Chow C, Samakar K, Dobrowolsky A, Houghton CC, Bildzukewicz N, Lipham JC (2018) Hiatal hernia recurrence following magnetic sphincter augmentation and posterior cruroplasty: intermediate-term outcomes. Surg Endosc 32:3374–3379CrossRefPubMed
20.
Kuckelman JP, Phillips CJ, Hardin MO, Martin MJ (2017) Standard vs expanded indications for esophageal magnetic sphincter augmentation for reflux disease. JAMA Surg 152:890–891CrossRefPubMedPubMedCentral
21.
Johnson LF, Demeester TR (1974) Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62:325–332PubMed
22.
Alicuben ET, Bildzukewicz N, Samakar K, Katkhouda N, Dobrowolsky A, Sandhu K, Lipham JC (2019) Routine esophageal manometry is not useful in patients with normal videoesophagram. Surg Endosc 33:1650–1653CrossRefPubMed
23.
Velanovich V, Karmy-Jones R (1998) Measuring gastroesophageal reflux disease: relationship between the Health-Related Quality of Life score and physiologic parameters. Am Surg 64:649–653PubMed
24.
Pohl H, Pech O, Arash H, Stolte M, Manner H, May A, Kraywinkel K, Sonnenberg A, Ell C (2016) Length of Barrett's oesophagus and cancer risk: implications from a large sample of patients with early oesophageal adenocarcinoma. Gut 65:196–201CrossRefPubMed
25.
Lidor AO, Kawaji Q, Stem M, Fleming RM, Schweitzer MA, Steele KE, Marohn MR (2013) Defining recurrence after paraesophageal hernia repair: Correlating symptoms and radiographic findings. Surgery 154:171–178CrossRefPubMed
26.
Hashemi M, Peters JH, Demeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, Demeester SR, Sillin LF, Bremner CG (2000) Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg 190:553–560CrossRefPubMed
27.
Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter. Prospect Randomized Trial 213:461–468
28.
Suppiah A, Sirimanna P, Vivian SJ, O’Donnell H, Lee G, Falk GL (2017) Temporal patterns of hiatus hernia recurrence and hiatal failure: quality of life and recurrence after revision surgery. Dis Esophagus 30:1–8CrossRefPubMed
29.
Lipham JC, Taiganides PA, Louie BE, Ganz RA, Demeester TR (2015) Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Dis Esophagus 28:305–311CrossRefPubMed
30.
Aiolfi A, Asti E, Bernardi D, Bonitta G, Rausa E, Siboni S, Bonavina L (2018) Early results of magnetic sphincter augmentation versus fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis. Int J Surg 52:82–88CrossRefPubMed
31.
Rebecchi F, Allaix ME, Giaccone C, Morino M (2013) Gastric emptying as a prognostic factor for long-term results of total laparoscopic fundoplication for weakly acidic or mixed reflux. Ann Surg 258:831–836 discussion 836-837CrossRefPubMed
32.
van Rijn S, Rinsma NF, van Herwaarden-Lindeboom MY, Ringers J, Gooszen HG, van Rijn PJ, Veenendaal RA, Conchillo JM, Bouvy ND, Masclee AA (2016) Effect of vagus nerve integrity on short and long-term efficacy of antireflux surgery. Am J Gastroenterol 111:508–515CrossRefPubMed
33.
Buckley FP 3rd, Bell RCW, Freeman K, Doggett S, Heidrick R (2018) Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation. Surg Endosc 32:1762–1768CrossRefPubMed
34.
Ayazi S, Chowdhury N, Zaidi AH, Chovanec K, Komatsu Y, Omstead AN, Zheng P, Hoppo T, Jobe BA (2020) Magnetic sphincter augmentation (MSA) in patients with hiatal hernia: clinical outcome and patterns of recurrence. Surg Endosc 34:1835–1846CrossRefPubMed
35.
Armijo PR, Pokala B, Misfeldt M, Pagkratis S, Oleynikov D (2019) Predictors of hiatal hernia recurrence after laparoscopic anti-reflux surgery with hiatal hernia repair: a prospective database analysis. J Gastrointest Surg 23:696–701CrossRefPubMed
36.
Abdelrahman T, Latif A, Chan DS, Jones H, Farag M, Lewis WG, Havard T, Escofet X (2018) Outcomes after laparoscopic anti-reflux surgery related to obesity: a systematic review and meta-analysis. Int J Surg 51:76–82CrossRefPubMed
37.
O'Riordan JM, Byrne PJ, Ravi N, Keeling PW, Reynolds JV (2004) Long-term clinical and pathologic response of Barrett's esophagus after antireflux surgery. Am J Surg 188:27–33CrossRefPubMed
38.
Oelschlager BK, Barreca M, Chang L, Oleynikov D, Pellegrini CA (2003) Clinical and pathologic response of Barrett's esophagus to laparoscopic antireflux surgery. Ann Surg 238:458–464 discussion 464-456CrossRefPubMedPubMedCentral
39.
Gurski RR, Peters JH, Hagen JA, DeMeester SR, Bremner CG, Chandrasoma PT, DeMeester TR (2003) Barrett's esophagus can and does regress after antireflux surgery: a study of prevalence and predictive features. J Am Coll Surg 196:706–712 discussion 712-703CrossRefPubMed
40.
Alicuben ET, Tatum JM, Bildzukewicz N, Samakar K, Samaan JS, Silverstein EN, Sandhu K, Houghton CC, Lipham JC (2019) Regression of intestinal metaplasia following magnetic sphincter augmentation device placement. Surg Endosc 33:576–579CrossRefPubMed
Metadata
Title
Magnetic sphincter augmentation with hiatal hernia repair: long term outcomes
Authors
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
Publication date
01-10-2021
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 10/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-08063-9

Other articles of this Issue 10/2021

Surgical Endoscopy 10/2021 Go to the issue

2020 SAGES Oral

Using telemedicine on an acute care surgery service: improving clinic efficiency and access to care

OriginalPaper

Impact of laparoscopic surgical experience on the learning curve of robotic rectal cancer surgery

OriginalPaper

T tube sinus tract duodenal fistula: a rare complication of postoperative choledochoscopy for treating retained intrahepatic stones

OriginalPaper

A scalable tool for adjudication of time sensitive cases during COVID-19 pandemic

Dynamic Manuscript

Endoscopic submucosal dissection using a detachable assistant robot: a comparative in vivo feasibility study (with video)

OriginalPaper

An evaluation of the complication risks following peroral endoscopic myotomy in patients on antithrombotic therapy