LONG TERM GASTROESOPHAGEAL REFLUX QUALITY OF LIFE OUTCOMES FOLLOWING LAPAROSCOPIC MAGNETIC SPHINCTER AUGMENTATION
Noah Switzer*, Carla Holcomb, Kayla Diaz, Andrew Suzo, Kyle A. Perry
Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH
INTRODUCTION. Laparoscopic magnetic sphincter augmentation (MSA) has gained favour as a primary antireflux procedure due to its technical simplicity, favorable side-effect profile and reproducibility. Its short-term efficacy has been reported in many comparative studies to the Nissen fundoplication. While these early results are promising, there remains a paucity of longer-term outcome data. We hypothesized that gastroesophageal reflux disease (GERD) patients treated with MSA will have sustained favourable long term GERD reported outcomes.
METHODS AND PROCEDURES:
We tested this hypothesis in a retrospective cohort study of consecutive adult patients undergoing the LINX procedure for GERD at a large academic medical center between 2013 and 2015. Demographic, preoperative, operative and outcome data were collected and maintained in an IRB approved database. Reflux symptoms and disease-specific quality of life were assessed using the Gastroesophageal Reflux Symptom Scale (GERSS) and Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) questionnaires. Analysis was performed using Stata 12 with a significance level of p<0.05. Data are presented as mean (range) or median (IQR) as appropriate.
RESULTS. A total of 25 patients (12 males, 13 females) underwent MSA with a mean age of 51.6[24 -71] years and a mean BMI score of 26.81[18-37] kg/m2. Mean preoperative DeMeester score was 34.2 [17-94]. GERD-HRQL scores improved from a median score of 46.0 [37-52] at baseline to 9.5[2.5-15.5] at 6 weeks, to 8.0[5.5-18.5] at the latest recorded follow-up interval, approximately 3.3 years. GERSS scores improved from a median score of 33.0[23-43.5] at baseline to 13.0[2-26] at 6 weeks, to 6.0[0-17] at 3.3 years. There were no erosions or serious events reported. Dysphagia requiring endoscopic dilation occurred in 16% of patients. Three patients (12%) went back on daily antiacid medication and 2(8%) patients went back on an as needed basis. The device explant rate during this interval was 8%(n=2) with a mean interval to device removal of 21[20-22] months. Reasons for removal included patient preference due to ineffective reflux control (n=1) and severe bloating (n=1).
CONCLUSION. The LINX magnetic sphincter augmentation appears to have sustained control of GERD at longer follow-up intervals, with minimal serious safety considerations. A small percentage of patients will require endoscopic dilation, resumption of antiacid medication or explant of their device.
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