Does Treatment of the Hiatus Influence the Outcomes of Magnetic Sphincter Augmentation for Chronic GERD?

  • Matías Mihura Irribarra
  • Sandra Blitz
  • Candice L. Wilshire
  • Anee Sophia Jackson
  • Alexander S. Farivar
  • Ralph W. Aye
  • Christy M. Dunst
  • Brian E. LouieEmail author
2018 SSAT Plenary Presentation



Hiatal dissection, restoration of esophageal intra-abdominal length, and crural closure are key components of successful antireflux surgery. The necessity of addressing these components prior to magnetic sphincter augmentation (MSA) has been questioned. We aimed to compare outcomes of MSA between groups with differing hiatal dissection and closure.


We retrospectively reviewed 259 patients who underwent MSA from 2009 to 2017. Patients were categorized based on hiatal treatment: minimal dissection (MD), crural closure (CC), formal crural repair (FC), and extensive dissection without closure (ED). The primary outcome was normalization of postoperative DeMeester score (≤ 14.72). Univariable and multivariable logistic regression was used to assess which preoperative predictors achieved normalization.


Of the 197 patients, MD was used in 81 (41%); FC in 42 (22%); CC in 40 (20%); and ED in 34 (17%). Normalization occurred in 104 (53%) patients, with MD achieving normalization in 45/81 (56%); FC in 25/42 (60%); CC in 21/40 (53%); and ED 13/34 (38%). After regression, FC was most likely to normalize acid exposure. The presence of a hiatal hernia, defective LES, and higher preoperative DeMeester score were less likely to achieve normalization.


Hiatal dissection with restoration of esophageal length and crural closure during MSA increases the likelihood of normalizing acid exposure.


Magnetic sphincter GERD Hiatal hernia Surgical outcomes Antireflux surgery Diaphragm 



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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Matías Mihura Irribarra
    • 1
  • Sandra Blitz
    • 2
  • Candice L. Wilshire
    • 3
  • Anee Sophia Jackson
    • 3
  • Alexander S. Farivar
    • 3
  • Ralph W. Aye
    • 3
  • Christy M. Dunst
    • 4
  • Brian E. Louie
    • 3
    Email author
  1. 1.Division of Foregut and Bariatric Surgery, General Surgery DepartmentBuenos Aires British HospitalBuenos AiresArgentina
  2. 2.Sandra Blitz StatisticsKelownaCanada
  3. 3.Division of Thoracic SurgerySwedish Medical Center and Cancer InstituteSeattleUSA
  4. 4.MIS Surgery, The Oregon ClinicPortlandUSA

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