Antiporda Michael, Jackson Chloe, Smith C Daniel, Bowers Steven P
1 Department of Surgery, Mayo Clinic in Florida , Jacksonville, Florida.
2 Esophageal Institute of Atlanta , Atlanta, Georgia .
J Laparoendosc Adv Surg Tech A. 2019 Feb;29(2):198-202. doi: 10.1089/lap.2018.0598. Epub 2018 Dec 15.
Laparoscopic magnetic sphincter augmentation (MSA) has been shown to be efficacious therapy for gastroesophageal reflux disease (GERD) refractory to maximal medical management. Herein, we present our experience with this procedure and an analysis of our outcomes.
Medical records were retrospectively reviewed of 98 patients who underwent laparoscopic MSA for GERD at a single institution from 2012 to 2016. Symptoms were assessed with gastroesophageal reflux disease-health-related quality of life (GERD-HRQL) questionnaire. Objective testing included pH testing, manometry, endoscopy, and upper GI series. Postimplantation interventions were recorded. Median follow-up was 46 months.
Median preoperative DeMeester score was 32 (interquartile range 21-46). Esophagitis was present in 18%. Hiatal hernia was present in 59%. Operation required full hiatal dissection in 16%. There were no intraoperative complications. Mean hospital stay postimplantation was 18 hours. Reoperative intervention with device explant was necessary in 5 cases, one of which was for intraluminal device erosion. Median GERD-HRQL scores were 25 preoperatively, 8 in short-term follow-up at median 1 month, and 5 in long-term follow-up at median 46 months. Improvement in GERD-HRQL scores was statistically significant with both short and long term compared with preoperative (P < .05), but no different between short- and long-term follow-up. Daily bothersome dysphagia was present in 19 patients preoperatively and in 9 at long-term follow-up.
Laparoscopic MSA is associated with excellent outcomes with decrease in GERD-HRQL scores in short term that are durable to longer term follow-up, and with low rates of new-onset dysphagia.
腹腔镜磁括约肌增强术（MSA）已被证明是对最大药物治疗无效的胃食管反流病（GERD）的有效治疗方法。在此，我们介绍我们在该手术方面的经验并分析我们的结果。
回顾性分析了2012年至2016年在单一机构接受腹腔镜MSA治疗GERD的98例患者的病历。使用胃食管反流病 - 健康相关生活质量（GERD - HRQL）问卷评估症状。客观检查包括pH测试、测压、内镜检查和上消化道造影。记录植入后的干预措施。中位随访时间为46个月。
术前中位DeMeester评分为32（四分位间距21 - 46）。18%的患者存在食管炎。59%的患者存在食管裂孔疝。16%的手术需要完全游离食管裂孔。无术中并发症。植入后平均住院时间为18小时。5例患者需要进行取出装置的再次手术干预，其中1例是因为腔内装置侵蚀。GERD - HRQL评分术前中位数为25，术后1个月短期随访时为8，术后46个月长期随访时为5。与术前相比，GERD - HRQL评分在短期和长期随访中均有统计学显著改善（P < 0.05），但短期和长期随访之间无差异。术前19例患者有每日困扰的吞咽困难，长期随访时有9例。
腹腔镜MSA具有良好的效果，GERD - HRQL评分在短期内降低，且长期随访持续存在，新发吞咽困难发生率低。
