Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation
Open Access
- 21 September 2017
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 32 (4), 1762-1768
- https://doi.org/10.1007/s00464-017-5859-4
Abstract
Introduction Magnetic sphincter augmentation (MSA) of the lower esophageal sphincter restores the antireflux barrier in patients with hiatal hernias ≤3 cm. We performed a prospective study in patients undergoing MSA with the LINX device during repair of paraesophageal and hernias over 3 cm axial component. Methods and procedures Multicenter, prospective study of consecutive patients treated with MSA at the time of repair of hiatal hernias >3 cm. Results 200 patients (110 female) were treated between March 2014 and February 2017 via laparoscopic hernia repair and MSA. Mean age was 59.5 years, mean BMI 29.4. 40% had esophagitis, 20% intestinal metaplasia, 72 of 77 tested had abnormal pH studies. Preoperative PPI use was reported by 87%. Eighteen patients had prior hiatal hernia/fundoplication. All had normal function. 78% of patients had axial hiatal hernia ≥5 cm or large paraesophageal component. Mean operative time was 81 min (38–193), EBL was 10 cc. Non-permanent mesh reinforcement of hiatal repair was performed in 83% of the patients. There were two readmissions for dehydration; 2 patients with pulmonary embolism, and 1 patient with cardiac ischemia. Nineteen patients required dilation. 156 pts were followed at a median of 8.6 months. GERD-HRQL scores improved from 26 preoperatively to 2 postoperatively. Complete PPI independence was achieved in 94% (147/156). Videoesophagram in 51 patients at median 11 months found 3 asymptomatic hernias 3 cm hernias undergoing MSA with hiatoplasty resulted in favorable outcomes with median of 9 months follow-up. Comparing this to published reports of MSA in patients with <3 cm hernias, the safety and clinical efficacy of MSA are independent of initial hernia size.Keywords
This publication has 31 references indexed in Scilit:
- Esophageal Sphincter Device for Gastroesophageal Reflux DiseaseThe New England Journal of Medicine, 2013
- The LINX® reflux management system: confirmed safety and efficacy now at 4 yearsSurgical Endoscopy, 2012
- Tailored or Routine Addition of an Antireflux Fundoplication in Laparoscopic Large Hiatal Hernia Repair: A Comparative Cohort StudyWorld Journal of Surgery, 2010
- History, Molecular Mechanisms, and Endoscopic Treatment of Barrett's EsophagusGastroenterology, 2010
- The rise and fall of antireflux surgery in the United StatesSurgical Endoscopy, 2006
- Biologic Prosthesis Reduces Recurrence After Laparoscopic Paraesophageal Hernia RepairTransactions of the ... Meeting of the American Surgical Association, 2006
- The crural diaphragm, an external lower esophageal sphincter: A definitive studyGastroenterology, 1993
- Paraesophageal hiatal hernia: Is an antireflux procedure necessary?The Annals of Thoracic Surgery, 1993
- Hiatus HerniaAnnals of Surgery, 1973
- Comparison of Crural Repair and Nissen Fundoplication in the Treatment of Esophageal Hiatus Hernia with Peptic EsophagitisAnnals of Surgery, 1971