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首页> 外文期刊>Surgical Endoscopy >Magnetic sphincter augmentation (MSA) in patients with hiatal hernia: clinical outcome and patterns of recurrence
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Magnetic sphincter augmentation (MSA) in patients with hiatal hernia: clinical outcome and patterns of recurrence

机译：磁性括约肌增强（MSA）在疝气疝患者中：临床结果和复发模式

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Introduction Magnetic sphincter augmentation (MSA) is an effective treatment for patients with gastroesophageal reflux disease. In early studies, patients with a hiatal hernia (HH) >= 3 cm were excluded from consideration for implantation and initially the FDA considered its use as "precautionary" in this context. This early approach has led to an attitude of hesitance among some surgeons to offer this therapy to patients with HH. This study was designed to evaluate the impact of HH status on the outcome of MSA and to report the rate of HH recurrence after MSA. Methods and procedures This is a retrospective review of prospectively collected data of patients who underwent MSA between June 2013 and August 2017. Baseline clinical and objective data were collected. Patients were divided into four groups based on HH status: no HH, small HH ( = 3 cm), and paraesophageal hernia (PEH). Patient satisfaction, GERD-HRQL and RSI data, freedom from PPI, need for postoperative dilation, length of hospitalization, 90-day readmission rate, need for device removal, and HH recurrence was compared between groups. Results There were 350 patients [60% female, mean (SD) age: 53.5 (13.8)] who underwent MSA. There were 65 (18.6%) with no HH, 205 (58.6%) with small HH ( = 3 cm) and 22 (6.2%) with PEH. At a mean follow-up of 13.6 (10.4) months, the rate of outcome satisfaction was similar between the groups (86%, 87.9%, 92.2% and 93.8%, p = 0.72). This was also true for GERD-HRQL total score clinical improvement (79.1%, 77.8%, 82% and 87.5%, p = 0.77). The rate of postoperative dysphagia (p = 0.33) and freedom from PPIs (p = 0.96) were similar among the four groups. Duration of hospitalization was higher among those with a large HH or PEH, and only PEH patients had a higher 90-day readmission rate (p = 0.0004). There was no difference between the need for dilation among groups (p = 0.13). The need for device removal (5% overall) was similar between the four groups (p = 0.28). HH recurrence was 10% in all groups combined, and only 7 of 240 (2.9%) patients required reoperation; the majority of these patients underwent a minimal dissection approach (no hernia repair) at the index operation. The incidence of recurrent HH increased in direct correlation with the preoperative HH size (0%, 10.1%, 16.6 and 20%, p = 0.032). Conclusion In the largest series of MSA implantation, we demonstrate that the excellent outcomes and high degree of satisfaction after MSA are independent of the presence or size of HH. Despite higher rates of hernia recurrence in large HH and PEH patients, the rates of postoperative endoscopic intervention, and device removal is similar to those with no or small HH. The minimal dissection approach to MSA should be abandoned.
机译：引言磁性括约肌增强（MSA）是胃食管反流患者的有效治疗方法。在早期研究中，患有血管疝气（HH）> = 3厘米的患者被排除在植入中，并且最初，FDA在这种情况下被视为“预防性”。这种早期的方法导致了一些外科医生犹豫不决的态度，向HH的患者提供这种治疗。本研究旨在评估HH地位对MSA结果的影响，并在MSA后报告HH复发率。方法和程序这是对预期收集的患者2013年6月至2017年八月期间的患者的预期收集数据。基线临床和客观数据被收集。患者基于HH的状态分为四组：没有HH，小HH（= 3cm）和PeheSophageal疝（PEH）。患者满意度，GERD-HRQL和RSI数据，来自PPI的自由，需要术后扩张，住院时间，90天即将入院率，群体之间需要去除，以及HH复发。结果有350名患者[60％女性，平均值（SD）年龄：53.5（13.8）]谁接受了MSA。有65个（18.6％）没有HH，205％（58.6％），小HH（= 3cm）和22（6.2％）。在13.6（10.4）个月的平均随访中，群组之间的成果满意度相似（86％，87.9％，92.2％和93.8％，p = 0.72）。对于GERD-HRQL总得分临床改善也是如此，这也是如此（79.1％，77.8％，82％和87.5％，p = 0.77）。在四组中，术后吞咽困难（P = 0.33）的速率（P = 0.33）和PPI的自由度相似。住院期间的持续时间较高，其中HH或PEH大，只有PEH患者的患者的入院率较高（P = 0.0004）。在组之间的扩张需求之间没有差异（p = 0.13）。在四组（P = 0.28）之间，对装置去除（总体总体5％）的需求相似。所有群体的HH复发为10％，只有240名（2.9％）患者中只需要重新开始;这些患者的大多数患者在指数运行中经历了最小的解剖方法（没有疝气修复）。复发HH的发病率与术前HH尺寸直接相关（0％，10.1％，16.6和20％，P = 0.032）。结论在最大的MSA植入系列中，我们证明了MSA之后的出色成果和高度满意度与HH的存在或大小无关。尽管大型HH和PEH患者的疝气复发率较高，但术后内窥镜干预的速率和装置去除率类似于没有或小HH的速率。应该放弃最小的解剖方法。

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