Reginald Bell, MD1, F.P. Tripp Buckley, MD2, Katherine Freeman, NP, MSN1, Rachel Heidrick, RN1, Stephanie Doggett, PAC2. 1SurgOne Foregut Institute, 2Baylor Scott & White-Round Rock
Introduction: Magnetic sphincter augmentation (MSA) of the lower esophageal sphincter restores the antireflux barrier in patients with hiatal hernias <3 cm. We report results in patients undergoing MSA with the LINX device during repair of paraesophageal and larger hernias.
Methods and Procedures: Multicenter, prospective study of consecutive patients treated with MSA at the time of repair of hiatal hernias >3 cm by either preoperative or intraoperative measurements. Values reported are mean (range).
Results: A total of 114 patients (64 females, 50 males) were treated between March 2014 and May 2016. Mean age was 61.2 years (25-92), mean BMI 29.1 (19.5-37.4). At baseline, 42% had esophagitis, 18% had intestinal metaplasia, and 32 of 35 tested had abnormal pH studies. Current PPI use was reported by 76%. Eight-five percent of patients had GERD documented by esophagitis, Barrett’s esophagus, abnormal pH, and/or PPI use. Eleven patients had prior hiatal hernia/fundoplication. All patients had normal esophageal clearance by manometry (47) or barium swallow (73).
Mean axial hiatal hernia height was 5.8 cm (3-18 cm) and radial was 5.5 cm (3-15 cm ). 102 patients had axial hiatal hernia > 5cm or large paraesophageal component.
Mean operative time was 87 minutes (38-193), EBL was <20 cc in all. No major perioperative complications occurred. Biologic mesh reinforcement of hiatal repair was performed in 85% (100/114) of the patients. Five patients underwent postoperative dilation.
86 pts were available for follow up at a mean of 8.6 months. Mean GERD-HRQL scores pre & post-op were 26 and 5, respectively. Complete PPI independence was achieved in 91% (78/86).
Objective studies at 6-12 months in 35 patients demonstrated 2 Recurrences: one asymptomatic recurrent hernia > 2cm, and one subject with a <2 cm hernia (LINX just above diaphragm ) at 6 months. The latter patient had hiatal repair due to dysphagia, with resolution and intact repair at 12 months. There have been no device explants, erosions or migrations to date.
Conclusions: Magnetic sphincter augmentation in patients with paraesophagal and large hernias is associated with favorable 6-12 month results. Follow-up is ongoing to further understand the role and outcomes of magnetic sphincter augmentation with large and paraesophageal hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79761
Program Number: S148
Presentation Session: Foregut 3
Presentation Type: Podium