Hiatal hernia recurrence after magnetic sphincter augmentation

Design

Multicentre observational cohort from prospective registries

Population

258 adults with moderate or large hiatal hernias (196 magnetic augmentation, 62 fundoplication)

Primary outcome

Objective hiatal hernia recurrence at 3 years

Effect

6.1% vs 21.0% (P=0.002); adjusted OR for fundoplication 4.67 (95% CI 1.11 to 19.59)

Six high-volume foregut centres pooled registry data on 258 patients with moderate (3–5 cm) or large hiatal hernias who had primary repair with either magnetic sphincter augmentation (196) or laparoscopic fundoplication (62), and objective imaging follow-up at three years.

Objective recurrence was 6.1% after magnetic augmentation and 21.0% after fundoplication. After adjustment, fundoplication was associated with higher odds of recurrence (OR 4.67, 95% CI 1.11 to 19.59). Reflux quality-of-life scores, dysphagia, bloating, satisfaction and revision rates were similar. Fewer patients needed a proton pump inhibitor after augmentation (11.5% vs 27.5%).

This is not randomised, the groups were unequal in size, and selection for each operation was by surgeon judgement. The wide confidence interval shows how uncertain the size of the effect is.

Magnetic augmentation is expensive and little used in India. The practical lesson is that anatomical recurrence and symptoms do not track closely, so both need to be part of how a repair is judged.

• Recurrent hiatal hernia is the commonest cause of failure after antireflux surgery
• Symptoms and anatomy diverged here; assess recurrence objectively when planning revision
• Magnetic sphincter augmentation was linked to lower recurrence, but this was not a randomised comparison
• Patient-reported outcomes were the same with either operation

Why it matters

It shows anatomical durability and symptom relief can tell different stories about the same operation.

Don't overread it

Patients were not randomised, so surgeon selection may explain part of the difference in recurrence.

The statistics, in plain English

The odds ratio of 4.67 has a confidence interval from 1.11 to 19.59, which barely excludes no effect and leaves the true size very uncertain. With only 62 fundoplications, a few cases either way would shift it.

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