Magnetic Sphincter Augmentation Versus Fundoplication in Non-obese Gastroesophageal Reflux Disease (GERD) Patients: A Systematic Review of Patient-Reported Outcomes and Dysphagia

TL;DR

This study compares two surgical treatments for GERD in non-obese patients, finding that both are effective but with different trade-offs in terms of function and side effects.

Contribution

The study provides a systematic review comparing MSA and LF specifically in non-obese GERD patients, highlighting functional outcomes and dysphagia risks.

Findings

Both MSA and LF significantly improved GERD-related quality of life in non-obese patients.

MSA showed better preservation of belching and reduced bloating but had higher rates of persistent dysphagia.

Patient satisfaction was high for both procedures, though MSA had slightly higher reoperation and hernia recurrence rates.

Abstract

Magnetic sphincter augmentation (MSA) and laparoscopic fundoplication (LF) are established surgical treatments for gastroesophageal reflux disease (GERD). While several comparative studies exist, evidence specifically focusing on non-obese populations remains less extensively characterized. This systematic review evaluates the effectiveness, functional outcomes, and safety profiles of MSA versus LF in non-obese adults with GERD. The protocol was registered with Prospective Register of Systematic Reviews (PROSPERO: CRD420251106241). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted across PubMed, ScienceDirect, Cochrane Library, and Google Scholar. Comparative studies published from 2015 to 2025 were included if they reported outcomes of MSA and LF in non-obese adults (BMI < 30). Data extraction focused on demographics, GERD-Health Related Quality of Life (GERD-HRQL), proton pump inhibitor (PPI) discontinuation, dysphagia, bloating, belching, and complications. Risk of bias was assessed using the Newcastle-Ottawa Scale. Eight studies with 1,598 patients met the inclusion criteria; 1,078 underwent MSA and 520 received LF. Both interventions significantly improved GERD-HRQL scores. Across the five studies reporting PPI discontinuation, rates were numerically higher with MSA in three studies and higher with LF in two. Overall, findings were mixed and no consistent advantage emerged. MSA patients reported better preservation of belching and reduced bloating. However, persistent dysphagia was more frequent in MSA, with predictors including preoperative dysphagia and weak esophageal motility. Long-term data indicated comparable GERD control but slightly higher reoperation and hernia recurrence rates with MSA. Patient satisfaction was high in both groups, with MSA favored for function-preserving outcomes such as reduced bloating and preserved ability to belch and vomit. MSA and LF both offer effective symptom relief in non-obese GERD patients. MSA demonstrates advantages in physiological function and reversibility but carries a higher risk of early dysphagia. It may be a preferred option in well-selected patients, although further randomized trials are needed to define its role as a primary surgical choice.

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