Jocelyn F Burke, MD1, Evan T Alicuben, MD1, Reginald C Bell, MD2, John C Lipham, MD1. 1Department of Surgery, Keck Medical Center of the University of Southern California, 2Institute of Esophageal and Reflux Surgery
Background: Magnetic sphincter augmentation (MSA) was FDA approved as a surgical option for patients with gastroesophageal reflux disease (GERD) in 2012. However, for patients with a body-mass index (BMI) ≥ 35, use of MSA is considered precautionary by the FDA. Debate exists on the effectiveness of Nissen fundoplication in this group. Roux-en-Y gastric bypass is considered an alternative to Nissen fundoplication for patients with a high BMI but is a much more extensive surgery than either fundoplication or MSA. We sought to determine the effectiveness and safety of MSA for treatment of GERD in patients with BMI ≥ 35.
Methods: We retrospectively analyzed data of patients undergoing magnetic sphincter augmentation (MSA) surgery between 2007 and 2018 from prospectively collected databases at two esophageal surgery centers. We compared clinical, diagnostic, intraoperative, and postoperative results for patients with BMI ≥ 35 to those with BMI < 35.
Results: A total of 623 patients underwent laparoscopic MSA, 43 with BMI ≥ 35 (“obese”) and 580 with BMI < 35 (“normal weight”). The populations were similar in age, duration of GERD symptoms, and preoperative GERD-Health-related quality of life (GERD-HRQL) survey and pH study DeMeester scores. The obese patients had a higher percentage of females (77% vs. 46%, p=0.0001) and larger hiatal hernia sizes measured via EGD (3.4 cm vs. 2.4 cm, p=0.006). Operative times were longer in obese patients (83 vs. 68 minutes, p=0.006), but hospital length of stay was similar (14.7 vs 13.1 hours, p=0.56). Most importantly, the postoperative courses were similar for both groups. At a median follow up of 11 months (range 1-94), postoperative complications were not significantly different (3% in obese vs. 10% in normal, p=0.13), though obese patients had lower rates of dysphagia (53% vs. 68%, p=0.05). Both populations had similar rates of GERD-HRQL symptom improvement or resolution at last follow up (84% vs. 85%, p=0.57), postoperative DeMeester score improvement (median score 7.2 vs. 7.4, p=0.67), low levels of continued PPI use (daily or occasionally, 21% vs. 19%, p=0.8), and low rates of recurrent hiatal hernia (11% vs. 10%, p=0.88).
Conclusions: MSA for the treatment of GERD achieves similar improvements in quality of life, reduction of reflux, and symptom control for patients with BMI ≥ 35. MSA represents a safe and effective option for GERD control in these patients who are unable or unwilling to undergo a more invasive Roux-en-Y gastric bypass surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95194
Program Number: P488
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster