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Loosening the belt on magnetic sphincter augmentation indications: does body mass index matter?

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Abstract

Background

Magnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA outcomes is unknown. The objective of this study was to evaluate the effectiveness of MSA in patients with GERD and obesity.

Methods

A retrospective cohort study was performed of consecutive patients who underwent laparoscopic MSA at three high-volume centers from 2016 to 2019. Patients were grouped into four cohorts according to the World Health Organization body mass index (BMI) classification: BMI < 25 (normal weight), BMI 25–29.9 (overweight), BMI 30–34.9 (obese class I), and BMI > 35 (obese class II–III). Preoperative, operative, and postoperative data were compared between groups.

Results

A total of 621 patients underwent laparoscopic MSA during the study period. Follow-up with endoscopy or video esophagram was available for 361 patients (58%) with a median follow-up of 15.4 months. Baseline characteristics of the groups were similar except the BMI > 35 group had more females and a higher preoperative median DeMeester score. There were no significant differences in outcomes between normal weight, overweight, and obese patient groups undergoing MSA. All groups experienced significant reductions in acid suppressive medication use, low GERD-HRQL scores, low DeMeester scores, few intraoperative and postoperative complications, and low rates of hiatal hernia recurrence after MSA.

Conclusions

Magnetic sphincter augmentation is safe and effective in improving GERD symptoms, reducing esophageal acid exposure, and preventing hiatal hernia recurrence, irrespective of patient BMI. MSA should be considered an acceptable treatment option for obese patients with GERD.

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Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Keck Medical Center of University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA

    Tayler J. James, Luke R. Putnam, Jennifer Pan, Nikolai A. Bildzukewicz & John C. Lipham

  2. Institute of Esophageal and Reflux Surgery, Englewood, CO, USA

    Jocelyn F. Burke & Reginald Bell

Authors
  1. Tayler J. James
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  2. Jocelyn F. Burke
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  3. Luke R. Putnam
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  4. Jennifer Pan
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  5. Nikolai A. Bildzukewicz
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  6. Reginald Bell
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  7. John C. Lipham
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Corresponding author

Correspondence to John C. Lipham.

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Disclosures

Dr. John C. Lipham is a consultant for Ethicon. Dr. Nikolai A. Bildzukewicz is a consultant for Ethicon, Intuitive, and Absolutions. Dr. Reginald Bell is a consultant for Ethicon, Intuitive, and BD. Drs. Tayler J. James, Jocelyn F. Burke, Luke R. Putnam, and Jennifer Pan have no conflicts of interest or financial ties to disclose.

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James, T.J., Burke, J.F., Putnam, L.R. et al. Loosening the belt on magnetic sphincter augmentation indications: does body mass index matter?. Surg Endosc 36, 4878–4884 (2022). https://doi.org/10.1007/s00464-021-08839-7

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  • DOI: https://doi.org/10.1007/s00464-021-08839-7

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