Abstract
Magnetic sphincter-augmentation (MSA) has been proven effective in the treatment of GERD. No consensus exists on whether crural closure should be performed. Our aim was to assess the impact of cruroplasty on reflux-control and quality of life. MSA-Patients treated between 03/2012-03/2017 were classified into those without hiatal hernia (“NHH”), those post-MSA (NHR) and those post-MSA/hiatal repair (HR). GERD-symptoms, PPI-intake, GERD-Health-related-Quality-of-Life (GERD-HRQL) and Alimentary Satisfaction were assessed. Sixty-eight patients underwent MSA, 26 patients had additional crural closure. PH-monitoring was negative in 80% of HR, 73% of NHR and 89% of NHH-patients. GERD-HRQL-total scores decreased significantly in all groups (p < 0.001). Alimentary satisfaction was 8/10 in HR/NHH and 10/10 in NHR-patients. Satisfaction with heartburn relief was high (HR: 96%, NR: 95%, NHH: 94%) as was the elimination of PPI-intake (HR/NHH: 87%, NR: 86%). Heartburn and regurgitations were eliminated in 100% of HR, 88% and 94% of NHR and 87% and 91% of NHH-patients. Endoscopic dilatation or device explantation was performed in 3% each. MSA leads to significant symptom relief, increased quality of life and alimentary satisfaction with low perioperative morbidity. Cruroplasty tends to result in better reflux control and symptom relief than exclusive MSA without increasing dysphagia rates.
Highlights
® augmentation (MSA) with a small device consistent of magnetic beats
The median size of hiatal hernia was similar in patients that underwent hiatal repair [2 cm (IQR, 2–3)] and those who had exclusive magnetic sphincter augmentation (MSA) without crural repair [2 cm (IQR, 1–3)]
The current study showed excellent alimentary satisfaction ranging from 8–10 out of possible 10, indicating that patients are comfortable after LINX implantation
Summary
® augmentation (MSA) with a small device consistent of magnetic beats The device is placed laparoscopically around the gastroesophageal junction to augment the barrier function of the lower esophageal sphincter (LES), suppressing reflux episodes while enabling the physiological functions of the LES uninhibited. This can be accomplished with either focused or full dissection. While MSA was initially limited to patients with small or no hiatal hernias Rona K. et al recently reported their encouraging outcomes of MSA in patients with hiatal hernias up to 7 cm They showed that these patients had similar postoperative symptom relief, decreased PPI requirement, GERD-HRQL scores and dysphagia rates as patients with smaller hernias. To our knowledge, no study has been published comparing outcomes of patients after exclusive MSA with those who have had MSA and additional crural closure
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