No added risk: national outcomes of magnetic sphincter explant with hiatal hernia repair and fundoplication.

BACKGROUND

Magnetic sphincter augmentation (MSA) is a ring of titanium beads that is implanted around the gastroesophageal junction for the management of gastroesophageal reflux disease, providing an alternative to traditional fundoplication. Despite positive outcomes, a subset of patients require device explantation. The safety of patients undergoing explant with revisional surgery remains limited to single-institution experiences. The objective of this study was to compare perioperative outcomes between patients undergoing MSA device explant with revisional surgery and those undergoing primary surgery using a national database.

METHODS

The 2017-2023 American College of Surgeons National Surgical Quality Improvement Program registry was queried for patients undergoing MSA removal with concurrent hiatal hernia repair and fundoplication. These patients were compared to a cohort undergoing primary hiatal hernia repair with fundoplication. Propensity score matching was performed in a 1:1 fashion based on baseline demographics, comorbidities, and procedure type to minimize selection bias. Outcomes of interest included operative time, length of stay, thirty-day postoperative complications, readmissions, and mortality.

RESULTS

A total of 49,535 patients underwent foregut surgery during the study period, of whom 40 (0.01%) underwent MSA device explant with revisional surgery. Following propensity score matching, each cohort included 40 patients. Overall demographics between the MSA and primary hernia repair groups were similar with the majority being female (87.5%), mean ages of 58.3 and 58.8 years, and BMI of 29.1 and 28.9 kg/m2, respectively. For both groups, the complication rate was 2.5% for readmission requiring revisional surgery, and median length of stay was one day. Median operative time was comparable. No mortalities were reported.

CONCLUSIONS

This study represents the largest national analysis of patients undergoing MSA device explant with concurrent revisional foregut surgery. Findings suggest that MSA device removal with hiatal hernia repair and fundoplication is safe, with perioperative outcomes equivalent to those of primary foregut surgery.