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Comment on "Objective Evidence of Reflux Control After Magnetic Sphincter Augmentation: 1 Year Results From a Post Approval Study".

We read with great enthusiasm Louie et al’s recent manuscript regarding the use of magnetic sphincter augmentation (MSA) with the LINX Reflux Management System for the treatment of gastroesophageal reflux disease (GERD). We were pleased to learn that it provided improvement in patient quality of life and reduction in esophageal acid exposure 1 year after implantation of the device. We believe that this information can be practice-changing, but we are interested in further discussion regarding the MSA’s efficacy compared to Nissen fundoplication for treatment of GERD. For several decades, laparoscopic antireflux surgery has been a viable option for the long-term treatment of GERD. The Nissen fundoplication, innovated in 1956, was the first surgical antireflux therapy to be found effective for GERD treatment; however, many complications arose, such as dysphagia and gas-bloat syndrome. In response to these side effects, DeMeester pioneered and studied the advantages of a ‘‘floppy Nissen’’ in 1986, in which there were 3 modifications made to the original Nissen technique: enlarging the diameter of the bougie, shortening the length of the fundoplication, and mobilizing the gastric fundus. These changes to the original Nissen fundoplication provided a decrease in gas-bloat symptoms and dysphagia, and also allowed for the complete relaxation of the distal esophagus. As such, the laparoscopic Nissen continued to be an effective and choice treatment for GERD patients. Given the longstanding history of the Nissen as the gold standard treatment for this condition, we are interested to learn more