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Magnetic sphincter augmentation: a viable rescue therapy for symptomatic reflux following bariatric surgery

  • 2019 SAGES Oral
  • Published:
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Abstract

Introduction

Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are commonly performed bariatric procedures in obesity management. Gastroesophageal reflux disease (GERD) in this population has reported rates of 23–100%. GERD after LSG has been noted with recent studies demonstrating de novo reflux or symptom exacerbation despite weight loss. Fundoplication is not an option, and medically refractory GERD after LSG is usually treated with conversion to RYGB. GERD post-RYGB is a unique entity, and management poses a clinical and technical challenge. We evaluate safety and effectiveness of magnetic sphincter augmentation after bariatric surgery.

Materials and methods

A retrospective review of a prospectively maintained database was performed identifying patients that underwent LINX placement for refractory GERD after LSG, LRYGB, or duodenal switch across three institutions. Outcomes included complications, length of stay, PPI use, GERD-HRQL scores, and patient overall 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 30.1. Average pre-operative DeMeester score was 24.8. Pre-operatively, 5 patients were on daily PPI, 6 on BID PPI, and 1 on PPI + H2 blocker. We noted decreased medication usage post-operatively, with 4 patients taking daily PPI, and 9 off medication completely. A GERD-HRQL score was obtained pre- and post-operatively in 6 patients with average reduction from 25 to 8.5 (p value 0.002). Two patients experienced complications requiring endoscopic dilation after LINX placement. 100% of patients reported overall satisfaction post procedure.

Conclusion

LINX placement is a safe, effective treatment option for 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.

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Authors and Affiliations

  1. Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California of San Diego, MET Building, Lower Level, 9500 Gilman Drive MC 0740, La Jolla, CA, 92093-0740, USA

    Ryan C. Broderick, Joslin N. Cheverie, Arielle M. Lee, Rebeca Dominguez-Profeta, Robert Cubas, Garth R. Jacobsen, Bryan J. Sandler, Karl-Hermann Fuchs & Santiago Horgan

  2. Esophageal Institute of Atlanta, Atlanta, GA, USA

    C. Daniel Smith

  3. Division of Esophago-gastric and Bariatric Surgery, Hospital Italiano de Mendoza, Mendoza, Argentina

    Pablo Omelanczuk

Authors
  1. Ryan C. Broderick
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  2. C. Daniel Smith
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  3. Joslin N. Cheverie
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  4. Pablo Omelanczuk
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  5. Arielle M. Lee
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  6. Rebeca Dominguez-Profeta
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  7. Robert Cubas
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  8. Garth R. Jacobsen
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  9. Bryan J. Sandler
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  10. Karl-Hermann Fuchs
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  11. Santiago Horgan
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Corresponding author

Correspondence to Arielle M. Lee.

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Disclosures

Dr. Horgan has stock options with TORAX™ Medical Inc. Dr. Smith has a pending stock option payment from TORAX™ Medical Inc. Dr. Jacobsen has two grants with TORAX™ Medical Inc, the first for The CALIBER Study: Randomized Controlled Trial of LINX versus Double-Dose Proton Pump Inhibitor Therapy for Reflux Disease, and the second for A Post-Approval Study of the LINX ® Reflux management system. Drs. Broderick, Cheverie, Omelanczuk, Lee, Dominguez-Profeta, Cubas, Sandler, and Fuchs have no conflicts of interest or financial ties to disclose.

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Broderick, R.C., Smith, C.D., Cheverie, J.N. et al. Magnetic sphincter augmentation: a viable rescue therapy for symptomatic reflux following bariatric surgery. Surg Endosc 34, 3211–3215 (2020). https://doi.org/10.1007/s00464-019-07096-z

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