title: LINX®magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis.
abstract: The LINX®magnetic sphincter augmentation system (MSA) is a surgical technique with short-term evidence demonstrating efficacy in the treatment of medically refractory or chronic gastroesophageal reflux disease (GERD). Currently, the Nissen fundoplication is the gold-standard surgical treatment for GERD. We are the first to systematically review the literature and perform a meta-analysis comparing MSA to the Nissen fundoplication.
  
  
  
  A comprehensive search of electronic databases (e.g., MEDLINE, EMBASE, SCOPUS, Web of Science and the Cochrane Library) using search terms "Gastroesophageal reflux or heartburn" and "LINX or endoluminal or magnetic" and "fundoplication or Nissen" was completed. All randomized controlled trials, non-randomized comparison study and case series with greater than 5 patients were included. Five hundred and forty-seven titles were identified through primary search, and 197 titles or abstracts were screened after removing duplicates. Meta-analysis was performed on postoperative quality of life outcomes, procedural efficacy and patient procedural satisfaction.
  
  
  
  Three primary studies identified a total of 688 patients, of whom 273 and 415 underwent Nissen fundoplication and MSA, respectively. MSA was statistically superior to LNF in preserving patient's ability to belch (95.2 vs 65.9%, p < 0.00001) and ability to emesis (93.5 vs 49.5%, p < 0.0001). There was no statistically significant difference between MSA and LNF in gas/bloating (26.7 vs 53.4%, p = 0.06), postoperative dysphagia (33.9 vs 47.1%, p = 0.43) and proton pump inhibitor (PPI) elimination (81.4 vs 81.5%, p = 0.68).
  
  
  
  Magnetic sphincter augmentation appears to be an effective treatment for GERD with short-term outcomes comparable to the more technically challenging and time-consuming Nissen fundoplication. Long-term comparative outcome data past 1 year are needed in order to further understand the efficacy of magnetic sphincter augmentation.
authors.affiliation: Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre, 840-112 Street, Edmonton, T6G 2B7, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Skubleny
authors.affiliation: Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre, 840-112 Street, Edmonton, T6G 2B7, Canada. nswitzer@ualberta.ca.
authors.forename: Noah J
authors.identifier: 0000-0002-9273-1008
authors.initials: NJ
authors.lastname: Switzer
authors.affiliation: Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre, 840-112 Street, Edmonton, T6G 2B7, Canada.
authors.forename: Jerry
authors.initials: J
authors.lastname: Dang
authors.affiliation: Department of Surgery, Faculty of Medicine and Dentistry, University of Calgary, Calgary, Canada.
authors.forename: Richdeep S
authors.initials: RS
authors.lastname: Gill
authors.affiliation: Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Canada.
authors.forename: Xinzhe
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre, 840-112 Street, Edmonton, T6G 2B7, Canada.|Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: de Gara
authors.affiliation: Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre, 840-112 Street, Edmonton, T6G 2B7, Canada.|Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Canada.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Birch
authors.affiliation: Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors.forename: Clarence
authors.initials: C
authors.lastname: Wong
authors.affiliation: Department of Surgery, Harvard Medical School, Boston, MA, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hutter
authors.affiliation: Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre, 840-112 Street, Edmonton, T6G 2B7, Canada.|Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Canada.
authors.forename: Shahzeer
authors.initials: S
authors.lastname: Karmali
mesh_terms: D003680:Deglutition Disorders / Q000453:epidemiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004884:Eructation; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000601:surgery*; D006356:Heartburn / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D059346:Magnets; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors
keywords: Fundoplication; GERD; Magnetic sphincter augmentation