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LINX, Nissen fundoplication comparably improve quality of life in chronic GERD patients

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LINX therapy improved quality of life comparable to Nissen fundoplication in patients with chronic GERD, according to data presented at the Society of American Gastrointestinal and Endoscopic Surgeons 2015 Annual Meeting.

Aiming to compare perioperative and clinical outcomes between LINX (magnetic sphincter augmentation, Torax Medical) and Nissen fundoplication, researchers performed a retrospective review of prospectively collected data on patients with chronic GERD who underwent either procedure at multiple centers. They evaluated demographics, baseline endoscopic findings and reflux characteristics, operating time, length of stay and morbidities, and postoperative outcome measures included GERD health-related quality of life (HRQL) scores, whether patients resumed using proton pump inhibitors, dysphagia, gas bloat, ability to belch and vomit, and overall patient-reported satisfaction.

Patients who underwent LINX (n = 186) had a BMI of 27 kg/m² compared with 28 kg/m² (P < .05) in patients who underwent Nissen fundoplication (n = 214). Hiatal hernia size was 1 cm vs. 2 cm (P < .01) and prevalence of Barrett’s esophagus was 17% vs. 32% (P < .01) between LINX and Nissen patients, respectively. Operating time was 57 minutes with LINX compared with 76 minutes with Nissen (P < .01) and length of stay was 11 hours vs. 32 hours (P < .01), respectively. No mortalities occurred and morbidities were comparable.

At least a year of follow-up was achieved with 72% of LINX patients and 71% of Nissen patients, for whom respective GERD HRQL scores were 21 and 19 before surgery vs. 3 and 3 after surgery. Gas bloat was experienced in 7% of LINX patients compared with 16% of Nissen patients (P < .05), eructation ability was retained in 98% vs. 82% (P < .01) and emesis ability was retained in 94% vs. 34% (P < .01), respectively. Dysphagia after surgery was similar between groups.

PPI use was resumed in 19% of LINX patients compared with 13% of Nissen patients (P < .05), and 83% vs. 92% reported satisfaction with the procedure (P < .05), respectively, although patients in both groups were equally likely to report they would undergo the procedure again.

The researchers concluded that both procedures improve quality of life in patients with chronic GERD. Thus, LINX is an alternative to Nissen fundoplication, although there are differences in efficacy, adverse effects and patient satisfaction, which “can be used to educate patients regarding the advantages and disadvantages of each option and assist in informed decision making, allowing for an individualized and potentially optimized approach to anti-reflux surgery.” – by Adam Leitenberger

Reference: 

Warren HF, et al. Abstract S034. Presented at: Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting; April 15-18, 2015, Nashville, Tenn.

Disclosure: Relevant financial disclosures were not provided.