Abstract
BackgroundMagnetic sphincter augmentation (MSA) is a modern treatment option for gastroesophageal reflux disease (GERD); however, laparoscopic fundoplication remains the gold standard. The aim of the study was to evaluate outcomes of MSA patients at a reflux center.MethodsA retrospective review was performed of all patients that underwent MSA between March 2012 and November 2017. Out of 110 patients, 68 with a follow-up >3 months were included. Postoperative gastrointestinal symptoms, proton pump inhibitor (PPI) intake, GERD-Health-related Quality of Life (GERD-HRQL) and alimentary satisfaction (AS) were assessed. Postoperative esophageal functioning tests were performed in 50% of patients.ResultsSixty-eight patients underwent MSA; hiatal repair was performed in 31 cases. The median OR time was 27 min, and no intraoperative complications occurred. The median follow-up was 13 months (IQR 4.2–45). Endoscopic dilatation was performed in 2 patients (3%) and device removal in another 2 cases. The postoperative GERD-HRQL score was significantly reduced (3 vs. 24; p < 0.001) and the median AS was 8/10. Preoperative experienced heartburn, regurgitations and dysphagia were eliminated in 92, 96 and 100%. Postoperative new-onset difficulties swallowing with solids only were reported to occur occasionally by 16% and rarely by 21% of patients. Satisfaction with heartburn relief was 95%, and the overall outcome was rated excellent/good in 89%. PPI dependency was eliminated in 87%. The median total percentage pH < 4 and number of reflux episodes were significantly reduced. Postoperative pH results were negative or slightly above the norm in 79% and 12%, respectively.ConclusionSphincter augmentation results in significantly reduced reflux symptoms, increased GERD-specific Quality of Life and excellent alimentary satisfaction with low perioperative morbidity. This procedure should be considered an excellent alternative to fundoplication in the treatment of GERD.
Highlights
The incidence of chronic gastroesophageal reflux disease (GERD) is constantly rising, currently affecting up to 25% of the general population [1, 2]
Sphincter augmentation results in significantly reduced reflux symptoms, increased GERD-specific Quality of Life and excellent alimentary satisfaction with low perioperative morbidity. This procedure should be considered an excellent alternative to fundoplication in the treatment of GERD
We found sphincter augmentation to result in significant symptom relief, high postoperative satisfaction, significantly improved GERD-related Quality of Life and excellent alimentary satisfaction with low perioperative morbidity
Summary
The incidence of chronic gastroesophageal reflux disease (GERD) is constantly rising, currently affecting up to 25% of the general population [1, 2]. The first-line therapy for GERD consists of acid suppression with proton pump inhibitors (PPIs), while the surgical gold standard is the laparoscopic fundoplication [1, 3, 4]. Proton pump inhibitors (PPIs) effectively reduce symptoms in approximately 60% of patients by increasing the pH of gastric refluxate. They do not address the function of the lower esophageal sphincter (LES) and the reflux itself persists, leaving the potential for development of progressive disease [1, 5,6,7,8]. Magnetic sphincter augmentation (MSA) is a modern treatment option for gastroesophageal reflux disease (GERD); laparoscopic fundoplication remains the gold standard. Postoperative pH results were negative or slightly above the norm in 79% and 12%, respectively
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