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. 2018 May 9;8(1):7319.
doi: 10.1038/s41598-018-24322-1.

Crural Closure improves Outcomes of Magnetic Sphincter Augmentation in GERD patients with Hiatal Hernia

Affiliations

Crural Closure improves Outcomes of Magnetic Sphincter Augmentation in GERD patients with Hiatal Hernia

Katrin Schwameis et al. Sci Rep. .

Abstract

Magnetic sphincter-augmentation (MSA) has been proven effective in the treatment of GERD. No consensus exists on whether crural closure should be performed. Our aim was to assess the impact of cruroplasty on reflux-control and quality of life. MSA-Patients treated between 03/2012-03/2017 were classified into those without hiatal hernia ("NHH"), those post-MSA (NHR) and those post-MSA/hiatal repair (HR). GERD-symptoms, PPI-intake, GERD-Health-related-Quality-of-Life (GERD-HRQL) and Alimentary Satisfaction were assessed. Sixty-eight patients underwent MSA, 26 patients had additional crural closure. PH-monitoring was negative in 80% of HR, 73% of NHR and 89% of NHH-patients. GERD-HRQL-total scores decreased significantly in all groups (p < 0.001). Alimentary satisfaction was 8/10 in HR/NHH and 10/10 in NHR-patients. Satisfaction with heartburn relief was high (HR: 96%, NR: 95%, NHH: 94%) as was the elimination of PPI-intake (HR/NHH: 87%, NR: 86%). Heartburn and regurgitations were eliminated in 100% of HR, 88% and 94% of NHR and 87% and 91% of NHH-patients. Endoscopic dilatation or device explantation was performed in 3% each. MSA leads to significant symptom relief, increased quality of life and alimentary satisfaction with low perioperative morbidity. Cruroplasty tends to result in better reflux control and symptom relief than exclusive MSA without increasing dysphagia rates.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Comparison of pre- and postoperative GERD-HRQL total scores (median with IQR) between groups (NHH left, NHR group mid, HR group right); the maximum total score reachable is 50, with a lower score indicating a better QOL.
Figure 2
Figure 2
Comparison of pre- and postoperative symptoms (%) between groups (NHH, NHR and HR groups).
Figure 3
Figure 3
Frequency and degree of postoperative dysphagia based on the classification of Saeed et al.. Columns from left to right: 0 = Unable to swallow (0%) I = Swallowing liquids with difficulty, solids impossible (0%) II = Swallowing liquids without difficulty, solids impossible (0%) III = Occasionally difficulty swallowing with solids (16%) IV = Rarely difficulty swallowing with solids (21%) V = Swallowing normally (63%).

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