Magnetic sphincter augmentation: A promising alternative to fundoplication for preserving lung function and protecting against chronic lung transplant rejection

• Published in: Transplantation reports 2024-09, Vol.9 (3), p.100156, Article 100156
• Main Authors: Huang, Estella Y, Afshar, Kamyar, Golts, Eugene, Broderick, Ryan C, Spurzem, Graham J, Chung, Daniel, Holmgren, Josefin, Sandler, Bryan J, Jacobsen, Garth R, Kunkel, David C, Horgan, Santiago
• Format: Article
• Language: English
• Subjects: Chronic lung disease; Gerd, Fundoplication; Lung transplant; Magnetic sphincter augmentation; Msa
• ISSN: 2451-9596; 2451-9596
• DOI: 10.1016/j.tpr.2024.100156

•An estimated 68 % of patients with end-stage lung disease experience GERD.•Reflux surgery stabilizes FEV1 in lung transplant and chronic lung disease patients.•Magnetic sphincter augmentation (MSA) is less invasive compared to fundoplication.•MSA is an advantageous alternative to fundoplication in lung transplant patients. Early laparoscopic fundoplication (LF) has been shown to slow lung function decline in chronic lung disease (CLD) patients and lung transplant (LTx) recipients. Magnetic sphincter augmentation (MSA) has emerged as an effective minimally invasive alternative to LF for the treatment of GERD. We evaluate the safety and efficacy of MSA compared to LF for GERD in CLD and LTx. A retrospective review identified CLD and LTx patients undergoing LF or MSA for GERD. Primary outcome was change in percent predicted FEV1. Secondary outcomes were 30d morbidity, mortality, operative time, and length of stay (LOS). 77 patients met inclusion criteria, 45 (58.5 %) were LTx recipients. 35 (45.5 %) underwent Nissen, 23 (29.9 %) underwent Toupet, and 19 (24.7 %) underwent MSA. Average age was 54.2 years, 54.5 % were female, and average BMI at ARS was 24.9 kg/m2. Median FEV1 % change between pre-ARS and post-ARS was 0 % with no significant differences between groups. MSA had faster operative times at 50.5 min than Nissen (83.5 min, p = 0.002) and Toupet (72.6 min, p = 0.003) and shorter LOS at 0.8 days than Nissen (3.7 days, p = 0.002) and Toupet (2.1 days, p = 0.0008). MSA and Nissen had higher reintervention rates than Toupet, though this was not statistically significant. There were no differences in 30-day morbidities or 30-day ED visits between groups. There were no mortalities. MSA is an advantageous alternative to LF in the CLD and LTx population with stabilization of percent predicted FEV1, equivalent safety profile, shorter operative times, and shorter length of hospital stay.