Magnetic Sphincter Augmentation: Poor Consensus Among Experts Regarding Key Technical Aspects of Implantation

Abstract

Background: 

Magnetic sphincter augmentation (MSA) of the lower esophageal sphincter is an effective alternative to Nissen fundoplication for the treatment of gastroesophageal reflux disease. Surgeons must be certified in patient selection, adequate mediastinal dissection, device sizing, and device implantation. This certification process is intended to ensure optimal outcomes and patient safety; however, for many key technical aspects of MSA, proper performance has not been clearly defined. The purpose of this study is to determine how often surgical experts agree on the technical aspects of the MSA procedure.

Materials and Methods: 

A 12-question survey investigated various technical aspects of the MSA procedure. The survey was sent to all certified MSA surgical proctors. Consensus on individual questions was defined as ≥70% agreement among the responding surgeons.

Results: 

The survey was sent to 37 certified MSA surgical proctors, 24 of whom responded (65%). The mean number of MSA procedures performed by the responders was 210. There was consensus on 4 of the 12 questions. The consensus was achieved indicating it is safe for MSA implantation in any size hiatal hernia, and that tension on the hiatal repair is not a factor to implant the MSA device. There was no consensus for 3 mediastinal dissection questions and only consensus on 2 of the 5 questions regarding MSA implantation. Once the device is implanted, there was no consensus for the appearance of the MSA device.

Conclusions: 

There is a need for procedure standardization to improve teaching and to maintain excellent efficacy and safety outcomes when the device is used in the community.