title: Laparoscopic Magnetic Sphincter Augmentation vs Laparoscopic Nissen Fundoplication: A Matched-Pair Analysis of 100 Patients.
abstract: BACKGROUND
  The efficacy and safety of magnetic sphincter augmentation (MSA) with the LINX device (Torax Medical) has been reported in several short-and long-term studies, rivaling historic results of laparoscopic Nissen fundoplication (LNF), but with fewer side effects. However, there have been no studies comparing patients with similar disease to validate these results.
  
  
  METHODS
  We conducted a retrospective analysis of 1-year outcomes of patients undergoing MSA and LNF from June 2010 to June 2013. Patients were matched using propensity scores incorporating multiple preoperative variables. Outcomes were measured by GERD Health Related Quality of Life scores, proton-pump inhibitor use, satisfaction, and complications.
  
  
  RESULTS
  One hundred and seventy-nine patients met inclusion criteria, 62 MSA and 117 LNF. Propensity score matching identified 50 patients in both groups using the "best-fit" model with a caliper of 0.5 SD. At 1 year after surgery, both groups had similar GERD Health Related Quality of Life scores (4.2 MSA and 4.3 LNF; p = 0.897) and proton-pump inhibitor use (17% of MSA and 8.5% of LNF; p = 0.355). Although there was no difference in the number of patients reporting mild gas and bloating (27.6% MSA and 27.6% LNF; p = 1.000), there were no patients with severe gas and bloating in the MSA group compared with 10.6% in the LNF group (p = 0.022). More LNF patients were unable to belch (8.5% of MSA and 25.5% of LNF; p = 0.028) or vomit (4.3% of MSA and 21.3% of LNF; p = 0.004). The incidence of postoperative dysphagia was similar between the groups (46.8% MSA and 44.7% LNF; p = 0.766).
  
  
  CONCLUSIONS
  Analogous GERD patients had similar control of reflux symptoms after both MSA and LNF. The inabilities to belch and vomit were significantly fewer with MSA, along with a significantly lower incidence of severe gas-bloat symptoms. These results support the use of MSA as first-line therapy in patients with mild to moderate GERD.
authors.affiliation: Department of General Surgery, Keck Medical Center of the University of Southern California, Los Angeles, CA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Reynolds
authors.affiliation: Department of General Surgery, Keck Medical Center of the University of Southern California, Los Angeles, CA.
authors.forename: Joerg
authors.initials: J
authors.lastname: Zehetner
authors.affiliation: Department of General Surgery, Keck Medical Center of the University of Southern California, Los Angeles, CA.
authors.forename: Phil
authors.initials: P
authors.lastname: Wu
authors.affiliation: Department of General Surgery, Keck Medical Center of the University of Southern California, Los Angeles, CA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of General Surgery, Keck Medical Center of the University of Southern California, Los Angeles, CA.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Bildzukewicz
authors.affiliation: Department of General Surgery, Keck Medical Center of the University of Southern California, Los Angeles, CA. Electronic address: john.lipham@med.usc.edu.
authors.forename: John C
authors.initials: JC
authors.lastname: Lipham
mesh_terms: D000328:Adult; D000368:Aged; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D059346:Magnets; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome