Comparative Outcomes of Laparoscopic Fundoplication and Magnetic Sphincter Augmentation for GERD: A Systematic Review and Meta-Analysis

IntroductionPatients with gastroesophageal reflux disease (GERD) who fail conservative therapy often undergo surgical intervention. While laparoscopic fundoplication (LF) is considered the standard procedure, the Magnetic Sphincter Augmentation (MSA) system has emerged as a promising alternative. Debate remains regarding their comparative effectiveness and safety. MethodsThis systematic review and meta-analysis examined studies comparing MSA to LF for GERD. We searched PubMed, Cochrane Central, and Embase databases using a comprehensive search strategy with multiple combinations of Medical Subject Headings (MeSH) terms and keywords related to gastroesophageal reflux disease, magnetic sphincter augmentation, LINX device, and fundoplication procedures. Key endpoints included symptom relief, quality of life, complications, recurrence, reoperation, and patient satisfaction. Studies were included if they were published in English, compared MSA (LINX Reflux Management System) with LF in patients diagnosed with GERD, and reported comparative outcomes. We excluded animal studies, case reports, case series, studies without relevant comparative data, and those with overlapping populations. Two independent reviewers screened studies using Rayyan software, with discrepancies resolved by a third reviewer. Data extraction was performed systematically using a standardized form, and quality assessment was conducted using the ROBINS-I tool for non-randomized studies. Meta-analysis was performed using random-effects models with risk ratios for dichotomous outcomes and standardized mean differences for continuous outcomes. ResultsTwelve studies, involving 11,690 patients (2,009 MSA; 9,681 LF), met inclusion criteria. MSA demonstrated significantly shorter operative times and hospital stays. Rates of postoperative complications, dysphagia, patient satisfaction, and reoperation did not differ significantly between groups. While both treatments provided comparable symptom control, MSA patients reported fewer gas and bloating issues, better ability to belch, and maintained the ability to vomit. There was no clear superiority of MSA over LF in terms of completely discontinuing proton pump inhibitors, although a slight trend favored MSA. ConclusionMSA and LF offer broadly similar outcomes for GERD, with no significant differences in safety, reoperation rates, and overall patient satisfaction. However, MSA may confer advantages in reducing operative times, hospital stays, gas-related symptoms, and preserving physiological functions such as belching and vomiting. These findings support the role of MSA as a viable alternative to LF, but further randomized controlled trials are needed to strengthen the evidence base and assist clinicians in tailored decision-making.