Abstract
Background
Magnetic sphincter augmentation (MSA) has been recognized as an effective treatment option for patients with gastroesophageal reflux disease. The feasibility of MSA in patients with prior gastric surgery has not been well established. This study aims to evaluate the safety and efficacy of MSA in patients with prior gastric surgery including bariatric and other anti-reflux operations.
Methods
A prospectively gathered registry approved by the institutional review board for patients undergoing anti-reflux surgery was retrospectively reviewed. All patients who underwent MSA were included. The patients were divided into two groups based on the presence of prior gastric surgeries compared to those without. Endpoints collected include differences between the two groups in their preoperative evaluation, perioperative course, and postoperative effectiveness.
Results
A total of 103 patients underwent MSA where 82 patients (80%) had no prior gastric surgery and 21 patients (20%) had prior gastric surgery. The prior gastric surgery group included 10 patients with prior anti-reflux surgery, 11 patients with prior bariatric surgery. Perioperative factors were higher in the prior gastric surgery group including operating room time (135 min vs. 93 min, p = < 0.001), number of beads used (16 vs. 14, p = < 0.001), and percent of patients staying overnight (47% vs. 5%, p = < 0.001). There was no difference in several factors of their preoperative evaluation including preoperative GERD-HRQL and RSI scores, hiatal hernia presence, or DeMeester score. Post-operative GERD-HRQL and RSI scores were not different as well as patient satisfaction, patients resuming PPI use, and device explant rate.
Conclusions
This study demonstrates equivalent outcomes with integration of MSA in patients with prior gastric surgery in comparison to patients without prior gastric surgery. However, these surgeries are longer, require larger devices, and patients are more likely to stay overnight.
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References
Reynolds JL et al (2015) Laparoscopic magnetic sphincter augmentation vs laparoscopic nissen fundoplication: a matched-pair analysis of 100 patients. J Am Coll Surg 221(1):123–128
Aiolfi A et al (2018) Early results of magnetic sphincter augmentation versus fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis. Int J Surg 52:82–88
Saino G et al (2015) Magnetic sphincter augmentation for gastroesophageal reflux at 5 years: final results of a pilot study show long-term acid reduction and symptom improvement. J Laparoendosc Adv Surg Tech A 25(10):787–792
Louie BE et al (2019) Objective evidence of reflux control after magnetic sphincter augmentation: one year results from a post approval study. Ann Surg 270(2):302–308
Buckley FP 3rd et al (2018) Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation. Surg Endosc 32(4):1762–1768
Rona KA et al (2017) Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias. Surg Endosc 31(5):2096–2102
Alicuben ET et al (2019) Regression of intestinal metaplasia following magnetic sphincter augmentation device placement. Surg Endosc 33(2):576–579
Oor JE et al (2016) Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg 211(1):250–267
Sebastianelli L et al (2019) Systematic Endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett's esophagus: results of a multicenter study. Obesity Surg 29(5):1462–1469
Broderick RC et al (2019) Magnetic sphincter augmentation: a viable rescue therapy for symptomatic reflux following bariatric surgery. Surg Endosc 34:3211–3215
Riva CG et al (2019) Magnetic Sphincter augmentation after gastric surgery. JSLS. https://doi.org/10.4293/JSLS.2019.00035
Ward MA et al (2019) Magnetic sphincter augmentation is an effective treatment for atypical symptoms caused by gastroesophageal reflux disease. Surg Endosc. https://doi.org/10.1007/s00464-019-07278-9
Hawasli A et al (2019) Laparoscopic placement of the LINX((R)) system in management of severe reflux after sleeve gastrectomy. Am J Surg 217(3):496–499
Kuckelman JP et al (2018) Esophageal magnetic sphincter augmentation as a novel approach to post-bariatric surgery gastroesophageal reflux disease. Obes Surg 28(10):3080–3086
Burgerhart JS et al (2014) Effect of sleeve gastrectomy on gastroesophageal reflux. Obes Surg 24(9):1436–1441
Del Genio G et al (2014) Sleeve gastrectomy and development of "de novo" gastroesophageal reflux. Obes Surg 24(1):71–77
Ribeiro MC et al (2016) late evaluation of patients operated for gastroesophageal reflux disease by nissen fundoplicatioN. Arq Bras Cir Dig 29(3):131–134
Brown AM et al (2019) Perioperative outcomes and quality of life after repair of recurrent hiatal hernia are compromised compared with primary repair. Am Surg 85(5):556–560
Vilar A et al (2018) Redo surgery after failure of antireflux surgery. Am Surg 84(11):1819–1824
Alicuben ET et al (2019) Routine esophageal manometry is not useful in patients with normal videoesophagram. Surg Endosc 33(5):1650–1653
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Steven G. Leeds—Consultant for Ethicon. Andrew Ngov, Gerald Ogola, Marc A. Ward have no conflicts of interest or financial ties to disclose.
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Leeds, S.G., Ngov, A., O. Ogola, G. et al. Safety of magnetic sphincter augmentation in patients with prior bariatric and anti-reflux surgery. Surg Endosc 35, 5322–5327 (2021). https://doi.org/10.1007/s00464-020-08025-1
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DOI: https://doi.org/10.1007/s00464-020-08025-1