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Is Magnetic Sphincter Augmentation a More Reproducible Procedure than Fundoplication for Gastroesophageal Reflux Disease?
Jessica Reynolds*1, Nikolai Bildzukewicz1, Kais Rona1, Brian E. Louie2, Heather F. Warren2, Paul Taiganides3, Stephanie Doggett4, Francis P. Buckley4, John Lipham1
1Surgery, University of Southern California, Los Angeles, CA; 2Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WA; 3Knox Community Hospital, Riverside, OH; 4General Surgery, Scott & White Health System, Round Rock, TX
Objective: To determine if there is variability in outcomes for magnetic sphincter augmentation (MSA) for gastroesophageal reflux disease (GERD) among providers.
Methods: Retrospective review of all MSA procedures performed by five surgeons at four institutions. Patients who had at least 3 months of follow up data were included in the study. Patient selection and eligibility for MSA were at the discretion of the individual surgeon. There were 296 patients identified who underwent MSA between 5/2009 and 6/2015 and had follow up data at 3 months post-operatively or greater. The number of procedures performed by each surgeon varied from 28 to 100. The institutions included an academic medical center, a large tertiary medical center, and a community medical center. All surgeons were experienced in foregut surgery and anti-reflux procedures.
Results: There was some variability in the patient population for each surgeon (Table 1) with significant differences in pre-operative GERD-HRQL scores, BMI, hiatal hernia size, and esophagitis grade. Median follow time between 8 and 12 months. Despite this, there was not a significant difference in post-operative GERD-HRQL scores (Table 2), which dropped significantly for all surgeons from 18-26 to 6-7, or PPI use which was 12-25%. There was a significant difference in the amount of post-operative dysphagia and dilation rates between surgeons, however dysphagia rates did not significantly correlate with dilation rates (R=0.089, p= 0.170)
Conclusion: Despite variability in surgeon experience and patient selection, there was no difference in post-operative GERD-HRQL scores or PPI use which supports good reproducibility for this procedure. The difference in dysphagia and dilation rates may reflect evolution of the expectations and management of this symptom over time.
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