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SHORT-TERM OUTCOMES PREDICT LONG-TERM PATIENT SATISFACTION IN PATIENTS UNDERGOING LAPAROSCOPIC MAGNETIC SPHINCTER AUGMENTATION
Michael Antiporda*1, Chloe A. Jackson1, Mauricia Buchanan1, C D. Smith2, Steven P. Bowers1
1General Surgery, Mayo Clinic Florida, Jacksonville, FL; 2Esophageal Institute of Atlanta, Atlanta, GA
Background: Laparoscopic magnetic sphincter augmentation (MSA) has been shown to be a safe and efficacious therapy for gastroesophageal reflux disease (GERD) refractory to maximal medical management. Herein we present our experience with this procedure and an analysis of our outcomes.
Methods: Medical records were retrospectively reviewed of 98 patients who underwent laparoscopic MSA for medically-refractory GERD at a single institution from 2012 to 2016. Symptom control was assessed with GERD-HRQL questionnaire. Objective testing included pH testing, manometry, endoscopy, and UGI. Post-implantation interventions and healthcare resource use were recorded. The study population was 44% male with median age 57 years and median BMI 26, with median follow-up of 46 months.
Results: Median preoperative DeMeester score was 32 (IQR 21-46). Esophagitis was present in 18%. Hiatal hernia was present in 59%. Operation required full hiatal dissection in 16%. There were no intra-operative complications. Mean hospital stay post-implantation was 18 hours. Re-operative intervention with device explantation was necessary in five cases, one of which was for intra-luminal device erosion. GERD-HRQL scores were median 25 preoperatively, 8 in short term follow-up at median 1 month, and 5 in long-term follow-up at median 46 months. Improvement in GERD-HRQL scores was statistically significant with both short and long-term compared to preoperative (P<0.05), but no different between short and long-term follow-up. Daily bothersome dysphagia was present in 19 patients preoperatively and in 7 at long-term follow-up.
Conclusion: Laparoscopic MSA is associated with excellent outcomes with decrease in GERD-HRQL scores in short term that are durable to longer term follow-up, and with low rates of new onset dysphagia.
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