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Early Postoperative Outcomes of Magnetic Gastroesophageal Junction Reinforcement Compared to Laparoscopic Nissen Fundoplication
Matthew R. Pittman*1, Anahita Jalilvand2, Andrew Suzo2, Edward L. Jones1, Kyle a. Perry1
1Center for Minimally Invasive Surgery, The Ohio State University, Columbus, OH; 2Surgery, The Ohio State University Medical Center, Columbus, OH
INTRODUCTION: Laparoscopic Nissen fundoplication (LNF) remains the standard of care for surgical management of GERD. Magnetic gastroesophageal junction reinforcement (MGJR) offers a novel surgical approach to address the dysfunctional lower esophageal sphincter. To date, studies comparing these procedures are lacking. The objective of this study was to compare the efficacy and side effects associated with LNF and MGJR in patients with symptomatic GERD.
METHODS: We performed a retrospective review of all patients undergoing LNF and MGJR between March of 2013 and October of 2014. Patients with BMI greater than 35 kg/m2, hiatal hernia more than 3cm, biopsy proven Barrett's Esophagus, severe erosive esophagitis, and distal esophageal pressures< 35 mmHg were excluded. Reflux symptoms and quality of life were assessed using the Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) questionnaire. Baseline and initial post-operative data were collected in the clinic setting while follow-up data was obtained using a telephone questionnaire. Median follow-up interval was 11 (5-20) months. Data are presented as incidence (%), mean ± SD, or median (range) as appropriate, and a p-value of <0.05 was considered statistically significant.
RESULTS: During the study period, 33 patients underwent LNF and 14 underwent MGJR. The groups did not differ in terms of age, gender, presence of hiatal hernia, esophagitis, DeMeester score, or baseling GERD-HRQL score, but the MGJR group had a lower mean BMI (29 ± 5.0 kg/m2) than patients undergoing LNF (29 ± 4.9 kg/m2, p=0.01). LNF required 78±14 minutes to perform compared to 48±12 minutes for MGJR (p<0.01), and median hospital stay was 1.2 days for LNF and 0.73 days for MGJR (p<0.01). Complications occurred in 2 (6%) patients following LNF and 2 (13%) following MGJR (p=0.58). GERD-HRQL improved significantly following both LNF (35 to 4, p<0.01) and LINX (28 to 4, p<0.01). At follow-up, no patient in either group was using daily anti-secretory medications. There were no statistically significant differences in significant post-operative dysphagia (30% vs 43%, p=0.50) or dysphagia at follow-up (23% versus 17%, p=1.00). Persistent significant bloating occurred in 46% following LNF and 0% of MGJR patients respectively (p=0.10).
CONCLUSION: LNF and MGJR both produce significant improvements in PPI dependence, GERD symptoms, and disease-specific quality of life. MGJR requires less time to perform and is associated with a decreased length of hospital stay. Post-operative dysphagia occurs in a significant proportion of patients after both procedures, but the incidence decreases with time. A trend towards less persistent bloating following MGJR was observed, though it did not reach statistical significance. Long-term follow-up studies will be required to establish the long-term efficacy of MGJR compared to LNF.
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