Magnetic sphincter augmentation device removal: surgical technique and results at medium-term follow-up

Abstract

Background The magnetic sphincter augmentation (MSA) device has become a common option for the treatment of gastroesophageal reflux disease (GERD). Knowledge of MSA-related complications, indications for removal, and techniques are puzzled. With this study, we aimed to evaluate indications, techniques for removal, surgical approach, and outcomes with MSA removal. Methods This is an observational singe-center study. Patients were followed up regularly with endoscopy, pH monitoring, and assessed for specific gastroesophageal reflux disease health-related quality of life (GERD-HRQL) and generic short-form 36 (SF-36) quality of life. Results Five patients underwent MSA explant. Four patients were males and the median age was 47 years (range 44–55). Heartburn, epigastric/chest pain, and dysphagia were commonly reported. The median implant duration was 46 months (range 31–72). A laparoscopic approach was adopted in all patients. Intraoperative findings included normal anatomy (40%), herniation in the mediastinum (40%), and erosion (20%). The most common anti-reflux procedures were Dor (n = 2), Toupet (n = 2), and anterior partial fundoplication (n = 1). The median operative time was 145 min (range 60–185), and the median hospital length of stay was 4 days (range 3–6). The median postoperative follow-up was 41 months (range 12–51). At the last follow-up, 80% of patients were off PPI; the GERD-HRQL and SF-36 questionnaire were improved with DeMeester score and esophageal acid exposure normalization. Conclusion The MSA device can be safely explanted through a single-stage laparoscopic procedure. Tailoring a fundoplication, according to preoperative patient symptoms and intraoperative findings, seems feasible and safe with a promising trend toward improved symptoms and quality of life.

Laparoscopic management of pathologic gastroesophageal reflux after sleeve gastrectomy using the magnetic sphincter augmentation (MSA) device—a Video Vignette

“…In the present study, we describe the medium-term outcomes after MSA device implant with LES resting pressure increase, distal esophageal acid exposure restoration and improved quality of life (GERD-HRQL: 6) [13]. Despite its rarity, MSA erosion has been described as potential MSA device implant drawback [14]. MSA device size mismatch, infection, as well as patient-related factors such as connective tissue disorders, steroids use and immunosuppression have been identified as potential risk factors for erosion [15].…”

Gastrointestinal Quality of Life in Gastroesophageal Reflux Disease: A Systematic Review

“…The application of a validated instrument to assess QOL in patients with a given disease allows for a comparison of this patient's QOL with a level of normal controls in order to make a judgment about the amount of QOL reduction this patient may suffer. Alternative instruments to assess QOL are available in the literature [6,10,13,15,[50][51][52]. The often applicated GERD-Healthrelated QOL score represents basically a symptom presence and symptom intensity score which consists of an assessment scale from 0 to 50, 50 being the worst possible measure [6,[50][51][52].…”

“…Alternative instruments to assess QOL are available in the literature [6,10,13,15,[50][51][52]. The often applicated GERD-Healthrelated QOL score represents basically a symptom presence and symptom intensity score which consists of an assessment scale from 0 to 50, 50 being the worst possible measure [6,[50][51][52]. The GERD-Health-related QOL has been promoted by several authors [6,[50][51][52].…”

“…The often applicated GERD-Healthrelated QOL score represents basically a symptom presence and symptom intensity score which consists of an assessment scale from 0 to 50, 50 being the worst possible measure [6,[50][51][52]. The GERD-Health-related QOL has been promoted by several authors [6,[50][51][52]. We have initially chosen the GIQLI as the QOL tool because of its applicability in all GI diseases.…”

The role of magnetic sphincter augmentation in the gastroesophageal reflux disease treatment pathway: the gastroenterology perspective

“…A single-center series of five patients who underwent MSA explantation with fundoplication reported four of the five patients were off PPI medications at median follow-up of 41 months. 38 Finally, the potential longer-horizon consequences of intrathoracic titanium implantation and exposure may warrant further monitoring and evaluation as longer-term data become available.…”