Z Gastroenterol 2016; 54 - KV428
DOI: 10.1055/s-0036-1587203

Efficacy of the LINX® reflux management system in patients with large hiatal hernias

J Zehetner 1, 2, KA Rona 2, JL Reynolds 2, K Schwameis 2, N Bildzukewicz 2, JC Lipham 2
  • 1Beau-Site Hirslanden Bern, Viszeralchirurgie, Bern, Switzerland
  • 2University of Southern California, Surgery, Los Angeles, USA

Background: Magnetic sphincter augmentation (MSA) with LINX® has demonstrated long-term safety and efficacy in patients with gastroesophageal reflux (GERD). The efficacy of LINX in patients with larger hiatal hernias has yet to be determined.

Methods: A retrospective review of all patients who underwent MSA at our institutions between May 2009 and December 2015 was performed. Information regarding demographics, GERD characteristics, intraoperative anatomic abnormalities, and surgical procedure was obtained. Clinical outcomes included postoperative GERD-Health Related Quality of Life (HRQL) scores, proton pump inhibitor (PPI) use, symptomatology, and complication rate. Larger hiatal hernias were 3 cm or greater by intraoperative measurement.

Results: The study included 192 patients. Median follow up time was 6 months (1 – 63 months). Mean GERD-HRQL scores decreased following LINX implantation (18.9 vs. 5.7, p < 0.001), and 89.5% of patients had improvement or resolution of their symptoms. Fifty-two patients had a larger (≥3 cm) hiatal hernia. GERD-HRQL scores decreased in patients with larger hiatal hernias following LINX (20.5 vs. 4.4, p < 0.001). When comparing outcomes in patients with larger hiatal hernias to those with smaller or no hiatal hernia, there was a significant decrease in postoperative PPI requirement (10.0% vs. 24.5%, p = 0.040) and a higher incidence of symptom improvement or resolution (98.1% vs. 87.7%, p = 0.028). There was a trend toward better mean postoperative GERD-HRQL scores (4.2 vs. 6.3, p = 0.059). There was no difference in dysphagia requiring intervention (9.6% vs. 15.7%, p = 0.354). There were no major complications.

Conclusion: MSA in patients with larger hiatal hernias demonstrates improved outcomes with respect to postoperative PPI requirement and symptom improvement. There is a trend toward better postoperative GERD-HRQL scores although the incidence of dysphagia requiring intervention is similar. MSA with LINX is a safe and effective option in patients with GERD and larger hiatal hernias.