title: Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias.
abstract: Magnetic sphincter augmentation (MSA) has demonstrated long-term safety and efficacy in the treatment of patients with gastroesophageal reflux (GERD), but its efficacy in patients with large hiatal hernias has yet to be proven. The aim of our study was to assess outcomes of MSA in patients with hiatal hernias ≥3 cm.
  
  
  
  We retrospectively reviewed all patients who underwent MSA at our institutions over a 6-year period. Information obtained consisted of patient demographics, symptoms of GERD, preoperative GERD Health-Related Quality-of-Life (HRQL) scores, perioperative details, and implantation of the MSA device. Primary endpoints included postoperative GERD-HRQL scores, proton-pump inhibitor (PPI) use, symptom change, and procedure-related complications. A large hiatal hernia was defined as a hernia measuring ≥3 cm by intraoperative measurement.
  
  
  
  A total of 192 patients were reviewed. Median follow-up was 20 months (3-75 months). Mean GERD-HRQL scores in the overall population before and after MSA were 18.9 and 5.0, respectively (p < 0.001). In the majority of patients symptoms improved or resolved (N = 177, p < 0.001). Fifty-two patients (27.0 %) had a hiatal hernia ≥3 cm (range 3-7 cm). Their mean GERD-HRQL score decreased from 20.5 to 3.6 (p < 0.001) following MSA. When compared to patients with smaller hernias, patients with large hiatal hernias had decreased postoperative PPI requirement (9.6 vs. 26.6 %, p = 0.011) and lower mean postoperative GERD-HRQL scores (3.6 vs. 5.6, p = 0.027). The percent of patients requiring postoperative intervention for dysphagia was similar (13.5 vs. 17.9 %, p = 0.522), as was the incidence of symptom resolution or improvement (98.1 vs. 91.3 %, p = 0.118).
  
  
  
  MSA in patients with large hiatal hernias demonstrates decreased postoperative PPI requirement and mean GERD-HRQL scores compared to patients with smaller hernias. The incidence of symptom resolution or improvement and the percentage of patients requiring intervention for dysphagia are similar. Short-term outcomes of MSA are encouraging in patients with gastroesophageal reflux disease and large hiatal hernias.
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Kais A
authors.initials: KA
authors.lastname: Rona
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Katrin
authors.initials: K
authors.lastname: Schwameis
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.|Department of General Surgery, Keck Hospital of USC, 1510 San Pablo St., HCC Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Joerg
authors.initials: J
authors.lastname: Zehetner
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.|Department of General Surgery, Keck Hospital of USC, 1510 San Pablo St., HCC Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Samakar
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Vong
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.|Department of General Surgery, Keck Hospital of USC, 1510 San Pablo St., HCC Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Kulmeet
authors.initials: K
authors.lastname: Sandhu
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.|Department of General Surgery, Keck Hospital of USC, 1510 San Pablo St., HCC Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Namir
authors.initials: N
authors.lastname: Katkhouda
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.|Department of General Surgery, Keck Hospital of USC, 1510 San Pablo St., HCC Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Bildzukewicz
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA. john.lipham@med.usc.edu.|Department of General Surgery, Keck Hospital of USC, 1510 San Pablo St., HCC Suite 514, Los Angeles, CA, 90033, USA. john.lipham@med.usc.edu.|James and Pamela Muzzy Endowed Chair in Gastrointestinal Cancer, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA. john.lipham@med.usc.edu.
authors.forename: John C
authors.initials: JC
authors.lastname: Lipham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000628:therapy*; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D055909:Magnetic Field Therapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors
keywords: GERD; Hiatal hernia; LINX; MSA; Magnetic sphincter augmentation