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DURABILITY OF ESOPHAGEAL ACID NORMALIZATION: A COMPARATIVE ANALYSIS OF NISSEN FUNDOPLICATION AND MAGNETIC SPHINCTER AUGMENTATION OVER TIME
Inanc Sarici
*1,3, Sven Eriksson
1,3, Johnathan Nguyen
1, Naveed Chaudhry
1, Mara Fryer
1, Ali H. Zaidi
1,2, Kirsten Newhams
1, Ping Zheng
1, Shahin Ayazi
1,2,31Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, PA; 2Department of Surgery, Drexel University, Pittsburgh, PA; 3Chevalier Jackson Research Fellowship, Esophageal Institute, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA
Introduction: Nissen fundoplication and magnetic sphincter augmentation (MSA) are well-established antireflux surgeries that offer effective and comparable reflux control over time. However, there is a paucity of data assessing and comparing the long-term durability of acid exposure normalization between two procedures. This study aims to evaluate distal esophageal acid exposure over time and assess the durability of acid exposure normalization following Nissen fundoplication and MSA with intact anatomy.
Methods: Patients who underwent primary Nissen fundoplication or MSA at our institution were included if they had an intact fundoplication or MSA device with no herniation on endoscopy and completed 48-hour wireless pH monitoring at both 1 year and 4 years postoperatively. The 1-year pH-study was performed at a mean (SD) of 16.3 (10) months following surgery, and the 4-year study at 48.0 (16) months. Distal esophageal acid exposure was assessed and compared at baseline, 1-year and 4-years after surgery. Normalization of acid exposure was defined as a DeMeester score <14.7.
Results: The final study population consisted of 188 patients who underwent Nissen fundoplication (n=71) or MSA (n=117) and had no evidence of herniated or disrupted fundoplication or device on endoscopy. More female patients underwent Nissen (80.3% vs. 63.2%, p = 0.0146). There were no significant differences in demographics, GERD-HRQL scores, or the degree of acid exposure between the groups (p > 0.05).
At 1-year after Nissen, GERD-HRQL scores improved from 24.5 (15-43) to 9.0 (2-23) (p<0.0001), and after MSA from 28.0 (16-49) to 6.0 (2-14), p<0.0001; Nissen and MSA were comparable (p=0.303). DeMeester scores decreased from 28.3 (18-47) to 2.1 (1-5), (p<0.0001) after Nissen with 94.4% normalization, and from 31.9 (20-47) to 5.0 (2-14) (p<0.0001) with 76.9% normalization after MSA. Nissen fundoplication had lower DeMeester scores (p<0.0001) with better normalization (p=0.002) than MSA.
From 1 to 4 years, GERD-HRQL scores remained unchanged after Nissen (p=0.315) and MSA (p=0.610) and remained comparable (p=0.247). DeMeester scores after Nissen (p=0.385) and MSA (p=0.221) also remained unchanged, with no change in normalization (p=0.346 and p=0.216, respectively)
(Table).
Conclusion: Nissen fundoplication and MSA both provide excellent reflux control and normalization of distal esophageal acid exposure over time in patients with intact repairs. While Nissen fundoplication achieved superior acid exposure normalization, both procedures maintained a consistent degree of acid exposure with no evidence of decline in normalization over time. This durability underscores their long-term efficacy for the management of GERD.
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