James M Tatum, MD, Evan Alicuben, MD, Nikolai Bildzukewicz, MD, Kameran Samakar, MD, Kulmeet Sandhu, MD, Caitlin Houghton, MD, John L Lipham, MD. Keck School Of Medicine Of The University Of Southern California
Introduction: Recurrent or persistent symptoms of reflux, dysphagia or device erosion can require removal of the magnetic sphincter augmentation (MSA) device. We describe patient characteristics, reasons for removal, immediate management, and short-term outcomes after removal.
Methods and Procedures: All patients undergoing removal of the MSA device in a single health system between March 2009 and September 2017. Initial operative and all post records were reviewed. Data were analyzed using SPSS (SPSS Inc.). Tests including Fishers's exact, Chi-square and t-test where used as appropriate.
Results: During the study period 435 MSA devices were implanted, 24 of which required removal (5.5%). The MSA device was removed due to refractory dysphagia in 2.3% (10/435), for recurrent or persistent GERD in 2.8% (12/435), and secondary to erosion in 0.5% (2/435). Mean age at implant was 54 (SD: 16); 50% (12/24) were female. Mean time from implant to removal was 863 days (Range 119-1762 days). The most common reasons for removal were persistent or recurrent GERD (54%), persistent dysphagia (38%), or device erosion into the esophagus (8%). Significant operative findings included device herniation (21%), location on the proximal stomach (8%), erosion (8%), and normal anatomy (46%). Hiatal hernia was found and repaired at the time of device removal in 38% of patients (9/24). The MSA device was removed through laparotomy (4%), endoscopically (4%), laparoscopically (88%), or through a combination of endoscopy and laparoscopy (4%). After removal patients underwent repeat MSA (33%), fundoplication (21%), gastrectomy (4%), or no additional procedure (42%). Mean operative time for removal was 107 (73) minutes; mean length of stay was 1.0 (0-10) days. Mean follow-up time after removal is 108 days. Symptoms prompting removal of the MSA device had resolved in 50% of patients and improved in an additional 38% at last contact. Of the 10 patients having no antireflux procedure after removal, 7 were available for follow up of whom 14% (1/7) had symptoms of GERD or required antireflux medication. No major complications occurred after removal and no patients have required immediate reoperation. Two patients had minor complications: a stricture at the erosion site at 364 days and a recurrence of a small hiatal hernia at 264 days.
Conclusions: While failure of the MSA device is rare, removal when necessary can generally be accomplished through minimally-invasive means. A definitive anti-reflux procedure is often performed at the time of removal with minimal morbidity. Longer follow up of these patients is needed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87430
Program Number: S137
Presentation Session: Plenary 2 Session
Presentation Type: Podium