Magnetic Sphincter Augmentation In Patients With Paraesophageal Hernia Vs. Large Sliding Hiatal Hernia: Comparison of Clinical Outcome And Complexity Of The Surgery

Introduction: Recent studies encourage the use of magnetic sphincter augmentation (MSA) in patients with large sliding hiatal hernia (LHH). However, the utility of MSA in patients with paraesophageal hernia (PEH) is poorly studied. The aim of this study is to compare the outcome and complexity of surgery in patients with PEH to those with LHH. Methods: A total of 37 (65% female) patients underwent PEH repair with MSA in our institution between 2013 and 2019. A group of 37, age/sex matched patients with LHH (≥ 4 cm) who underwent MSA formed the control group. The clinical outcome and the complexity of the surgery were then compared between groups. Results: At a median follow-up of 25.3 (17–35) months, there was significant improvement in the GERD-HRQL total-scores for PEH (18 vs. 3, p < 0.001) and LHH (26 vs. 4, p < 0.0001) patients when compared to preoperative values. The PEH group was similar to LHH group in regard to pH-normalization (71% vs. 64%, p = 0.76) and freedom from PPI (94.4% vs. 91.9%, p = 1.00). Small asymptomatic hernia recurrence was seen in 19% and 18% of LHH and PEH patients, respectively ( p  = 0.546). One patient (3%) required surgical intervention for symptomatic recurrence in each group. The rate of dysphagia and need for dilation were similar between the groups. No significant differences in operative time, blood loss, and hospital stay were detected between patients with PEH and those with LHH. However, there was a trend toward higher necessity for additional operative maneuvers (40.5% vs 13.5%, p  = 00.17) and longer hospital stay in PEH. Conclusion: Despite the inherent differences between LHH and PEH, repair of hernia and MSA results in high rate of favorable outcome and low rate of recurrence in both groups. GERD symptom control, freedom from PPI and improvement in quality of life are comparable. However, the greater need for additional surgical maneuvers and longer hospital stay reflect the greater complexity of procedures for repair of PEH with MSA.