Matías Mihura Irribarra1, Sandra Blitz2, Candice L Wilshire3, Anee Sophia Jackson3, Alexander S Farivar3, Ralph W Aye3, Christy M Dunst4, Brian E Louie5. 1. Division of Foregut and Bariatric Surgery, General Surgery Department, Buenos Aires British Hospital, Buenos Aires, Argentina. 2. Sandra Blitz Statistics, Kelowna, BC, Canada. 3. Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA. 4. MIS Surgery, The Oregon Clinic, Portland, OR, USA. 5. Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA. brian.louie@swedish.org.
Abstract
BACKGROUND: Hiatal dissection, restoration of esophageal intra-abdominal length, and crural closure are key components of successful antireflux surgery. The necessity of addressing these components prior to magnetic sphincter augmentation (MSA) has been questioned. We aimed to compare outcomes of MSA between groups with differing hiatal dissection and closure. METHODS: We retrospectively reviewed 259 patients who underwent MSA from 2009 to 2017. Patients were categorized based on hiatal treatment: minimal dissection (MD), crural closure (CC), formal crural repair (FC), and extensive dissection without closure (ED). The primary outcome was normalization of postoperative DeMeester score (≤ 14.72). Univariable and multivariable logistic regression was used to assess which preoperative predictors achieved normalization. RESULTS: Of the 197 patients, MD was used in 81 (41%); FC in 42 (22%); CC in 40 (20%); and ED in 34 (17%). Normalization occurred in 104 (53%) patients, with MD achieving normalization in 45/81 (56%); FC in 25/42 (60%); CC in 21/40 (53%); and ED 13/34 (38%). After regression, FC was most likely to normalize acid exposure. The presence of a hiatal hernia, defective LES, and higher preoperative DeMeester score were less likely to achieve normalization. CONCLUSIONS: Hiatal dissection with restoration of esophageal length and crural closure during MSA increases the likelihood of normalizing acid exposure.
BACKGROUND: Hiatal dissection, restoration of esophageal intra-abdominal length, and crural closure are key components of successful antireflux surgery. The necessity of addressing these components prior to magnetic sphincter augmentation (MSA) has been questioned. We aimed to compare outcomes of MSA between groups with differing hiatal dissection and closure. METHODS: We retrospectively reviewed 259 patients who underwent MSA from 2009 to 2017. Patients were categorized based on hiatal treatment: minimal dissection (MD), crural closure (CC), formal crural repair (FC), and extensive dissection without closure (ED). The primary outcome was normalization of postoperative DeMeester score (≤ 14.72). Univariable and multivariable logistic regression was used to assess which preoperative predictors achieved normalization. RESULTS: Of the 197 patients, MD was used in 81 (41%); FC in 42 (22%); CC in 40 (20%); and ED in 34 (17%). Normalization occurred in 104 (53%) patients, with MD achieving normalization in 45/81 (56%); FC in 25/42 (60%); CC in 21/40 (53%); and ED 13/34 (38%). After regression, FC was most likely to normalize acid exposure. The presence of a hiatal hernia, defective LES, and higher preoperative DeMeester score were less likely to achieve normalization. CONCLUSIONS: Hiatal dissection with restoration of esophageal length and crural closure during MSA increases the likelihood of normalizing acid exposure.
Authors: G M Campos; J H Peters; T R DeMeester; S Oberg; P F Crookes; S Tan; S R DeMeester; J A Hagen; C G Bremner Journal: J Gastrointest Surg Date: 1999 May-Jun Impact factor: 3.452
Authors: Reginald V N Lord; Steven R DeMeester; Jeffrey H Peters; Jeffrey A Hagen; Dino Elyssnia; Corinne T Sheth; Tom R DeMeester Journal: J Gastrointest Surg Date: 2008-12-03 Impact factor: 3.452
Authors: Shahin Ayazi; Jeffrey A Hagen; Joerg Zehetner; Oliver Ross; Calvin Wu; Arzu Oezcelik; Emmanuele Abate; Helen J Sohn; Farzaneh Banki; John C Lipham; Steven R DeMeester; Tom R Demeester Journal: J Gastrointest Surg Date: 2009-09-25 Impact factor: 3.452
Authors: Robert A Ganz; Jeffrey H Peters; Santiago Horgan; Willem A Bemelman; Christy M Dunst; Steven A Edmundowicz; John C Lipham; James D Luketich; W Scott Melvin; Brant K Oelschlager; Steven C Schlack-Haerer; C Daniel Smith; Christopher C Smith; Dan Dunn; Paul A Taiganides Journal: N Engl J Med Date: 2013-02-21 Impact factor: 91.245
Authors: Luigi Bonavina; Greta I Saino; Davide Bona; John Lipham; Robert A Ganz; Daniel Dunn; Tom DeMeester Journal: J Gastrointest Surg Date: 2008-10-10 Impact factor: 3.452
Authors: Brian E Louie; Seema Kapur; Maurice Blitz; Alexander S Farivar; Eric Vallières; Ralph W Aye Journal: J Gastrointest Surg Date: 2012-11-27 Impact factor: 3.452
Authors: Mikhail Attaar; Bailey Su; Harry Wong; Zachary Callahan; Kristine Kuchta; Stephen Stearns; John G Linn; Woody Denham; Stephen P Haggerty; Michael B Ujiki Journal: Surg Endosc Date: 2021-08-31 Impact factor: 3.453