Magnetic sphincter augmentation versus fundoplication for GERD: a systematic review and meta-analysis of postoperative outcomes.

BACKGROUND

Gastroesophageal reflux disease (GERD) is commonly treated with surgical interventions such as magnetic sphincter augmentation (MSA) or fundoplication (FP). This meta-analysis evaluates postoperative outcomes of MSA versus FP in GERD management.

METHODS

A systematic literature search was conducted across PubMed, Cochrane Library, ScienceDirect, and Embase up to April 2025, identifying studies comparing MSA and FP for GERD. Pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I 2 statistic, and statistical significance was set at P < 0.05.

RESULTS

Twelve studies, published between 2014 and 2024, were included. No significant differences were observed in postoperative proton pump inhibitors (PPI) use (OR: 0.70, 95% CI: 0.30-1.67, P = 0.40, I 2 = 85%) or GERD-HRQL scores (MD: 0.67, 95% CI: -0.57-1.91, P = 0.29, I 2 = 68%) and dysphagia (OR: 1.12, 95% CI: 0.59-2.14, P = 0.72, I 2 = 72%) between MSA and FP. MSA significantly improved the ability to belch (OR: 6.78, 95% CI: 4.49-10.22, P < 0.00001, I 2 = 43%) and ability to vomit (OR: 5.85, 95% CI: 2.39-14.33, P = 0.0001, I 2 = 82%) and reduced gas bloating risk (OR: 0.43, 95% CI: 0.25-0.75, P = 0.003, I 2 = 54%) compared to FP.

CONCLUSIONS

MSA and FP demonstrate comparable efficacy in GERD symptom control, PPI use, and dysphagia. MSA offers significant advantages in preserving the ability to belch and vomit and reducing gas bloating. Substantial heterogeneity in GERD-HRQL scores, postoperative PPI use, dysphagia, and ability to vomit warrants cautious interpretation, and further studies are needed to optimize surgical approaches.