Ryan C Broderick, MD, Joslin N Cheverie, MD, Arielle M Lee, MD, Bryan J Sandler, MD, Garth R Jacobsen, MD, Karl-Hermann Fuchs, MD, Santiago Horgan, MD. UC San Diego
Introduction: Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the two most commonly performed bariatric procedures for management of obesity. Gastroesophageal reflux disease (GERD) is highly prevalent in the obese population, rates ranging from 37-72%. Some studies demonstrated de novo or exacerbated reflux post-LSG. Fundoplication is no longer an option, and medically refractory GERD after LSG is traditionally treated with conversion to RYGB. GERD post LRYGB is a unique entity of its own and management poses a clinical and technical challenge. We present a case series of reflux management with magnetic sphincter augmentation after bariatric surgery.
Material and Methods: A retrospective review of a prospectively maintained database was performed to identify patients that underwent LINX placement for medically refractory GERD after either LSG, LRYGB, or duodenal switch across three institutions. Outcomes included complications, length of stay, reduction in PPI use, improvement in GERD-HRQL, and patient satisfaction.
Results: From March 2014 through June 2018, 13 identified patients underwent LINX placement after bariatric surgery: 8 LSG, 4 LRYGB, and 1 duodenal switch. The patients were 77% female, with mean age 43, and average BMI 30.08. Average pre-operative DeMeester score was 24.77. Pre-operatively, 5 patients were on daily PPI, 6 on BID PPI, and 1 on PPI+H2 blocker. We noted a decrease in medication usage post-operatively, with 5 patients requiring daily PPI, and 8 off medication completely. A GERD-HRQL score was obtained pre and post-operatively in 6 patients with an average reduction from 25 to 8.5 (p-value 0.002). 2 patients experienced complications (nausea, stricture),and 2 required endoscopic dilation after LINX placement. 100% of patients reported overall satisfaction post-procedure.
Conclusion: LINX placement is a safe, effective treatment option in the surgical management of refractory GERD after bariatric surgery. It can relieve symptoms and obviate the requirement of high dose medical management. Magnetic lower esophageal sphincter augmentation should be another tool in the surgeon’s toolbox for managing reflux after bariatric surgery in select patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94662
Program Number: S140
Presentation Session: Bariatric V – GERD and Esophageal Physiology
Presentation Type: Podium