title: Short-term outcomes using magnetic sphincter augmentation versus Nissen fundoplication for medically resistant gastroesophageal reflux disease.
abstract: BACKGROUND
  In 2012 the United States Food and Drug Administration approved implantation of a magnetic sphincter to augment the native reflux barrier based on single-series data. We sought to compare our initial experience with magnetic sphincter augmentation (MSA) with laparoscopic Nissen fundoplication (LNF).
  
  
  METHODS
  A retrospective case-control study was performed of consecutive patients undergoing either procedure who had chronic gastrointestinal esophageal disease (GERD) and a hiatal hernia of less than 3 cm.
  
  
  RESULTS
  Sixty-six patients underwent operations (34 MSA and 32 LNF). The groups were similar in reflux characteristics and hernia size. Operative time was longer for LNF (118 vs 73 min) and resulted in 1 return to the operating room and 1 readmission. Preoperative symptoms were abolished in both groups. At 6 months or longer postoperatively, scores on the Gastroesophageal Reflux Disease Health Related Quality of Life scale improved from 20.6 to 5.0 for MSA vs 22.8 to 5.1 for LNF. Postoperative DeMeester scores (14.2 vs 5.1, p=0.0001) and the percentage of time pH was less than 4 (4.6 vs 1.1; p=0.0001) were normalized in both groups but statistically different. MSA resulted in improved gassy and bloated feelings (1.32 vs 2.36; p=0.59) and enabled belching in 67% compared with none of the LNFs.
  
  
  CONCLUSIONS
  MSA results in similar objective control of GERD, symptom resolution, and improved quality of life compared with LNF. MSA seems to restore a more physiologic sphincter that allows physiologic reflux, facilitates belching, and creates less bloating and flatulence. This device has the potential to allow individualized treatment of patients with GERD and increase the surgical treatment of GERD.
authors: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington. Electronic address: brian.louie@swedish.org.
authors: Brian E
authors: BE
authors: Louie
authors: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington.
authors: Alexander S
authors: AS
authors: Farivar
authors: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington.
authors: Dale
authors: D
authors: Shultz
authors: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington.
authors: Christina
authors: C
authors: Brennan
authors: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington.
authors: Eric
authors: E
authors: Vallières
authors: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington.
authors: Ralph W
authors: RW
authors: Aye
mesh_terms: D016022:Case-Control Studies; D049630:Esophageal Sphincter, Lower; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D059346:Magnets; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome