Magnetic sphincter augmentation: A promising alternative to fundoplication for preserving lung function and protecting against chronic lung transplant rejection

Q4 Medicine Transplantation Reports Pub Date : 2024-06-25 DOI:10.1016/j.tpr.2024.100156
Estella Y Huang , Kamyar Afshar , Eugene Golts , Ryan C Broderick , Graham J Spurzem , Daniel Chung , Josefin Holmgren , Bryan J Sandler , Garth R Jacobsen , David C Kunkel , Santiago Horgan
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Abstract

Background

Early laparoscopic fundoplication (LF) has been shown to slow lung function decline in chronic lung disease (CLD) patients and lung transplant (LTx) recipients. Magnetic sphincter augmentation (MSA) has emerged as an effective minimally invasive alternative to LF for the treatment of GERD. We evaluate the safety and efficacy of MSA compared to LF for GERD in CLD and LTx.

Methods

A retrospective review identified CLD and LTx patients undergoing LF or MSA for GERD. Primary outcome was change in percent predicted FEV1. Secondary outcomes were 30d morbidity, mortality, operative time, and length of stay (LOS).

Results

77 patients met inclusion criteria, 45 (58.5 %) were LTx recipients. 35 (45.5 %) underwent Nissen, 23 (29.9 %) underwent Toupet, and 19 (24.7 %) underwent MSA. Average age was 54.2 years, 54.5 % were female, and average BMI at ARS was 24.9 kg/m2. Median FEV1 % change between pre-ARS and post-ARS was 0 % with no significant differences between groups. MSA had faster operative times at 50.5 min than Nissen (83.5 min, p = 0.002) and Toupet (72.6 min, p = 0.003) and shorter LOS at 0.8 days than Nissen (3.7 days, p = 0.002) and Toupet (2.1 days, p = 0.0008). MSA and Nissen had higher reintervention rates than Toupet, though this was not statistically significant. There were no differences in 30-day morbidities or 30-day ED visits between groups. There were no mortalities.

Conclusion

MSA is an advantageous alternative to LF in the CLD and LTx population with stabilization of percent predicted FEV1, equivalent safety profile, shorter operative times, and shorter length of hospital stay.

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磁性括约肌增强术:替代胃底折叠术保护肺功能和防止慢性肺移植排斥反应的有效方法
背景早期腹腔镜胃底折叠术(LF)已被证明可减缓慢性肺病(CLD)患者和肺移植(LTx)受者的肺功能衰退。磁性括约肌增强术(MSA)已成为治疗胃食管反流病的一种有效的微创替代方法。我们评估了磁性括约肌增强术与 LF 相比治疗 CLD 和 LTx 胃食管反流病的安全性和有效性。主要结果是预测 FEV1 百分比的变化。结果77例患者符合纳入标准,其中45例(58.5%)为LTx患者。35人(45.5%)接受了Nissen手术,23人(29.9%)接受了Toupet手术,19人(24.7%)接受了MSA手术。平均年龄为 54.2 岁,54.5% 为女性,ARS 时的平均体重指数为 24.9 kg/m2。ARS前和ARS后的中位FEV1变化率为0%,组间无显著差异。MSA 的手术时间为 50.5 分钟,快于 Nissen(83.5 分钟,p = 0.002)和 Toupet(72.6 分钟,p = 0.003),而 LOS 为 0.8 天,短于 Nissen(3.7 天,p = 0.002)和 Toupet(2.1 天,p = 0.0008)。MSA 和 Nissen 的再介入率高于 Toupet,但无统计学意义。各组间的 30 天发病率或 30 天急诊就诊率没有差异。结论 在CLD和LTx人群中,MSA是LF的一个有利替代方案,它能稳定预测FEV1百分比,安全性相当,手术时间更短,住院时间更短。
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来源期刊
Transplantation Reports
Transplantation Reports Medicine-Transplantation
CiteScore
0.60
自引率
0.00%
发文量
24
审稿时长
101 days
期刊介绍: To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI
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