Michael P Meara, MD, MBA, FACS, Colleen Alexander, MD, Cole Rodman, David B Renton, MD, FACS, Jennifer Schwartz, MD. The Ohio State University Wexner Medical Center
BACKGROUND: Magnetic esophageal sphincter augmentation is a relatively new technique for management for reflux beyond traditional medications. The long-term outcomes of this device and concerns for potential failure or erosion remain a paramount issue as the device is applied to an increasing number of individuals, both in the United States and worldwide.
This patient is a 49-year-old Caucasian female. She has a past surgical history significant for Linx device implantation in 2013. She noted since surgery that she had had no relief of her reflux and that in fact, her reflux had worsened to a point where the symptoms were lifestyle limiting. Manometry was consistent with implantation of a Linx device and pH probe study demonstrated a DeMeester score of 57.2. The patient desired Linx device explanation and operative fundoplication for management of her reflux.
METHODS: In light of the patient's previous operations, the decision was made to attempt a combined laparoscopic and robotic Linx device explanation and Nissen Fundoplication. Adhesions were minimal in nature and the Linx device was encountered with very minimal dissection. The device was removed from its capsule and a circumferential dissection was taken around the esophagus. Once adequate mobilization had been performed, the wire holding the device together was divided and the device was removed from the posterior aspect of the esophagus. The device was removed from the patient intact and the number of beads were confirmed with the previous operative report. Intraoperative endoscopy was performed to confirm there was no mucosal violation of the esophagus.
Finally, a standard Nissen fundoplication was performed with minimal impact on the procedure from the previously removed device.
CONCLUSIONS: This procedure can be completed safely and effectively. Robotic removal and repeat fundoplication can be considered in patient’s whose device has subsequently failed and removal is necessary.
KEY WORDS: Magnetic Esophageal Sphincter – Linx – Robotic Nissen Fundoplication – GERD – Robotic Redo Foregut Surgery
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88343
Program Number: V104
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo