Short term safety of magnetic sphincter augmentation vs minimally invasive fundoplication: an ACS-NSQIP analysis

Paul Wisniowski; Luke R Putnam; Shea Gallagher; Rushil Rawal; Caitlin Houghton; John C Lipham

doi:10.1007/s00464-024-10672-7

Short term safety of magnetic sphincter augmentation vs minimally invasive fundoplication: an ACS-NSQIP analysis

Surg Endosc. 2024 Apr;38(4):1944-1949. doi: 10.1007/s00464-024-10672-7. Epub 2024 Feb 9.

Authors

Paul Wisniowski¹, Luke R Putnam¹, Shea Gallagher¹, Rushil Rawal², Caitlin Houghton¹, John C Lipham³

Affiliations

¹ Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA.
² California University of Science and Medicine, Colton, CA, USA.
³ Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA. John.lipham@med.usc.edu.

Abstract

Purpose: Magnetic Sphincter Augmentation (MSA) is an FDA-approved anti-reflux procedure with comparable outcomes to fundoplication. However, most data regarding its use are limited to single or small multicenter studies which may limit the generalizability of its efficacy. The purpose of this study is to evaluate the outcomes of patients undergoing MSA vs fundoplication in a national database.

Materials and methods: The 2017-2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Registry was utilized to evaluate patients undergoing MSA or fundoplication. Patients requiring Collis gastroplasty, paraesophageal hernia repair, and emergency cases, were excluded. Patient outcomes included overall complication rates, readmissions, reoperations, and mortality.

Results: A total of 7,882 patients underwent MSA (n = 597) or fundoplication (n = 7285). MSA patients were younger (51 vs 57, p < 0.001), and more often male (49.6 vs 34.3%, p < 0.001). While patients undergoing MSA experienced similar rates of reoperation (1.0 vs 2.0%, p = 0.095), they experienced fewer readmissions (2.2 vs 4.7%, p = 0.005), complications (0.6 vs 4.0%, p < 0.001), shorter mean (SD) hospital length of stay(days) (0.4 ± 4.3 vs 1.8 ± 4.6, p < 0.001) and operative time(min) (80.8 ± 36.1 vs 118.7 ± 63.7, p < 0.001). Mortality was similar between groups (0 vs 0.3%, p = 0.175). On multivariable analysis, MSA was independently associated with reduced postoperative complications (OR 0.23, CI 0.08 to 0.61, p = 0.002), readmissions (OR 0.53, CI 0.30 to 0.94, p = 0.02), operative time (RC - 36.56, CI - 41.62 to - 31.49. p < 0.001) and length of stay (RC - 1.22, CI - 1.61 to - 0.84 p < 0.001).

Conclusion: In this national database study, compared to fundoplication MSA was associated with reduced postoperative complications, fewer readmissions, and shorter operative time and hospital length of stay. While randomized trials are lacking between MSA and fundoplication, both institutional and national database studies continue to support the use of MSA as a safe anti-reflux operation.

Keywords: Fundoplication; GERD; Gastroesophageal reflux disease; MSA; Magnetic sphincter augmentation.

MeSH terms

Esophageal Sphincter, Lower / surgery
Fundoplication / adverse effects
Fundoplication / methods
Gastroplasty*
Humans
Laparoscopy* / methods
Magnetic Phenomena
Male
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Quality Improvement
Quality of Life
Retrospective Studies
Treatment Outcome