Keith J King, MD, Ragui Sadek, MD, FACS, Andrew M Wassef, BS. Rutgers Robert Wood Johnson Medical School
Background: Magnetic sphincter augmentation (MSA) using the LINX® Reflux Management System provides an alternative surgical option for patients experiencing medically refractory gastroesophageal reflux disease (GERD) following laparoscopic sleeve gastrectomy (LSG). A critical component in successful MSA, particularly in patients with a previous LSG, is appropriate size selection and placement of the LINX® device. We present a novel case of managing medically refractory GERD with laparoscopic MSA after LSG using intraoperative impedance planimetry (EndoFLIP®) to measure esophagogastric junction (EGJ) distensibility.
Methods: In September 2018, laparoscopic LINX® magnetic sphincter device placement with intraoperative impedance planimetry was performed in a 58-year-old female with a DeMeester score of 51 who had undergone LSG 65 months prior. A small hiatal hernia was identified and repaired posteriorly in interrupted fashion. The sizing device was used to select a size 16 LINX® device which was placed in proper anatomic alignment. Intraoperative impedance planimetry measurements were taken to confirm adequate distensibility and an adequate crural repair. An EGJ distensibility index of 2 mm2/mmHg was measured.
Results: Laparoscopic MSA was well tolerated without complications and the patient was discharged home within 24 hours. She experienced some postoperative dysphagia which progressively improved during subsequent follow up. The severity and frequency of the patient’s reflux, regurgitation, and epigastric pain were significantly improved postoperatively compared to preoperative evaluation with a reduction of her GERD score.
Conclusions: Magnetic sphincter augmentation is a safe and effective surgical option for addressing medically refractory GERD in patients with a previous LSG. Using intraoperative impedance planimetry may provide benefit in appropriate device calibration and placement as well as potentially decreasing postoperative dysphagia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94953
Program Number: P484
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster