Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation

F P Buckley,Rachel Heidrick,Stephanie Doggett,Reginald C W Bell,Kate Freeman

doi:10.1007/s00464-017-5859-4

F P Buckley, Rachel Heidrick + Show 3 more

Open Access

https://doi.org/10.1007/s00464-017-5859-4

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Abstract

IntroductionMagnetic sphincter augmentation (MSA) of the lower esophageal sphincter restores the antireflux barrier in patients with hiatal hernias ≤3 cm. We performed a prospective study in patients undergoing MSA with the LINX device during repair of paraesophageal and hernias over 3 cm axial component.Methods and proceduresMulticenter, prospective study of consecutive patients treated with MSA at the time of repair of hiatal hernias >3 cm.Results200 patients (110 female) were treated between March 2014 and February 2017 via laparoscopic hernia repair and MSA. Mean age was 59.5 years, mean BMI 29.4. 40% had esophagitis, 20% intestinal metaplasia, 72 of 77 tested had abnormal pH studies. Preoperative PPI use was reported by 87%. Eighteen patients had prior hiatal hernia/fundoplication. All had normal function. 78% of patients had axial hiatal hernia ≥5 cm or large paraesophageal component. Mean operative time was 81 min (38–193), EBL was 10 cc. Non-permanent mesh reinforcement of hiatal repair was performed in 83% of the patients. There were two readmissions for dehydration; 2 patients with pulmonary embolism, and 1 patient with cardiac ischemia. Nineteen patients required dilation. 156 pts were followed at a median of 8.6 months. GERD-HRQL scores improved from 26 preoperatively to 2 postoperatively. Complete PPI independence was achieved in 94% (147/156). Videoesophagram in 51 patients at median 11 months found 3 asymptomatic hernias <3 cm. One symptomatic patient underwent successful repair of the hernia without MSA manipulation. There have been no device explants, erosions, or migrations to date.ConclusionsThis prospective study of 200 patients with >3 cm hernias undergoing MSA with hiatoplasty resulted in favorable outcomes with median of 9 months follow-up. Comparing this to published reports of MSA in patients with <3 cm hernias, the safety and clinical efficacy of MSA are independent of initial hernia size.

Highlights

Magnetic sphincter augmentation (MSA) of the lower esophageal sphincter restores the antireflux barrier in patients with hiatal hernias B3 cm
There have been no device explants, erosions, or migrations to date. This prospective study of 200 patients with [3 cm hernias undergoing MSA with hiatoplasty resulted in favorable outcomes with median of 9 months follow-up
Gastroesophageal reflux disease (GERD) is one of the most common diseases encountered by clinicians and its prevalence is estimated to be as high as 20–30% in westernized countries [1, 2]

Summary

Methods

Multicenter, prospective study of consecutive patients treated with MSA at the time of repair of hiatal hernias [3 cm. Non-permanent mesh reinforcement of hiatal repair was performed in 83% of the patients. Patients underwent routine dissection of the hernia sac and mediastinum until adequate esophageal length was obtained. Reinforcement of the hiatal repair was performed with a nonpermanent prosthetic mesh if deemed appropriate by the individual surgeon. The posterior vagus was elevated off the posterior esophagus and the MSA sizer was introduced. If the posterior vagus had been elevated for some distance, as occasionally occurred during dissection of a large hernia sac, a small polypropylene suture was placed from distal esophagus to perineurium of the posterior vagus distal to the MSA device to provide posterior anchoring.

Results

Discussion

Conclusion