Skip to main content
SpringerLink
Log in

Removing the magnetic sphincter augmentation device: operative management and outcomes

  • 2018 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Recurrent or persistent symptoms of reflux, dysphagia, or device erosion can lead to removal of the magnetic sphincter augmentation (MSA aka Linx) device. Device removal has been previously reported, and outcomes of various surgical management strategies at the time of removal have not been well described.

Methods

This is a retrospective review of patients undergoing MSA removal from March 2009 to September 2017 in a single institution. Reason for removal, operative management, and short-term outcomes are reported.

Results

During the study, 435 MSA devices were implanted, 24 of which required removal (5.5%). Removal was due to refractory dysphagia in 1.8% (8/435), for recurrent or persistent GERD in 2.9% (13/435), and secondary to erosion in 0.5% (2/435). Mean time from implant to removal was 863 days (range 119–1762 days). The most common reasons for removal were recurrent GERD (54%), dysphagia (38%), or erosion (8%). Significant operative findings included recurrent or progressive hiatal hernia (38%), 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%), laparoscopically (88%), or through a combination of endoscopy and laparoscopy (8%). After removal patients underwent repeat MSA (33%), fundoplication (21%), gastrectomy (4%), or no additional procedure (42%). Symptoms prompting removal of the MSA device had resolved in 52% of patients and improved in an additional 35% at last contact. Of the 10 patients having no anti-reflux procedure after removal, 9 were available for follow-up at a mean of 97 (106) days of whom 22.2% (2/9) had symptoms of GERD or required any anti-reflux medication. No major complications occurred after removal.

Conclusion

MSA removal when necessary can be accomplished through minimally invasive means. Repeat Linx or fundoplication can be performed after removal, however may not be necessary in patients with removal for dysphagia.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bonavina L, DeMeester T, Fockens P et al (2010) Laparoscopic sphincter augmentation device eliminates reflux symptoms and normalizes esophageal acid exposure: one- and 2-year results of a feasibility trial. Ann Surg 252:857–862

    Article  PubMed  Google Scholar 

  2. Ganz RA, Peters JH, Horgan S et al (2013) Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med 368:719–727

    Article  CAS  PubMed  Google Scholar 

  3. Reynolds JL, Zehetner J, Wu P, Shah S, Bildzukewicz N, Lipham JC (2015) Laparoscopic magnetic sphincter augmentation vs. laparoscopic nissen fundoplication: a matched-pair analysis of 100 patients. J Am Coll Surg 221:123–128

    Article  PubMed  Google Scholar 

  4. Pence MM, Hubbard M, Singla MB, Young PE. (2015) Esophagogastric fistula caused by an angelchik antireflux prosthesis. ACG Case Rep J 9:213–215

    Article  Google Scholar 

  5. Spann MD, Aher CV, English WJ, Williams DB. (2017) Endoscopic Management of erosion after banded bariatric procedures. Surg Obes Relat Dis 13:1875–1879

    Article  PubMed  Google Scholar 

  6. Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Brunt M, Hunter L, Demeester JG, Swanstrom TR, Daniel Smith LL, Filipi C (2009) CJ.Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 23:1219–1226

    Article  PubMed  Google Scholar 

  7. Asti E, Siboni S, Lazzari V, Bonitta G, Sironi A, Bonavina L. (2017) Removal of the magnetic sphincter augmentation device: surgical technique and results of a single-center cohort study. Ann Surg 265:941–945

    Article  PubMed  Google Scholar 

  8. Lipham JC, Taiganides PA, Louie BE, Ganz RA, DeMeester TR. (2015) Safety analysis of the first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux. Dis Esophagus 28:305–311

    Article  CAS  PubMed  Google Scholar 

  9. Smith CD, Ganz RA, Lipham JC, Bell RC, Rattner DW. (2017) Lower esophageal sphincter augmentation for gastroesophageal reflux disease: the safety of a modern implant. J Laparoendosc Adv Surg Tech A 27:586–591

    Article  PubMed  Google Scholar 

  10. Rona KA, Tatum JM, Zehetner J, Schwameis K, Chow C, Samakar K, Dobrowolsky A, Houghton CC, Bildzukewicz N, Lipham JC (2018) Hiatal hernia recurrence following magnetic sphincter augmentation and posterior cruroplasty: intermediate-term outcomes. Surg Endosc Jan 16. https://doi.org/10.1007/s00464-018-6059-6 [Epub ahead of print]

  11. Rona KA, Reynolds J, Schwameis K et al (2017) Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias. Surg Endosc 32:2096–2012

    Article  Google Scholar 

  12. Buckley FP 3rd. Bell RCW, Freeman K, Doggett S, Heidrick R. (2018) Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation. Surg Endosc 32:1762–1768

    Article  PubMed  Google Scholar 

  13. Parmar AD, Tessler RA, Chang HY, Svahn JD (2017) Two-stage explantation of a magnetic lower esophageal sphincter augmentation device due to esophageal erosion. J Lararoendosc Adv Surg Tech A 27:829–853

    Article  Google Scholar 

  14. Bauer M, Meining A, Dranzfelder M et al (2015) Endoluminal perforation of a magnetic antireflux device. Surg Endosc 29:3806–3810

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University Of Southern California, 1450 San Pablo StreetHealthcare Consultation Center 4Suite 6200, Los Angeles, CA, 90033, USA

    James M. Tatum, Evan Alicuben, Nikolai Bildzukewicz, Kamran Samakar & Caitlin C. Houghton

  2. Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University Of Southern California, 1510 San Pablo St. Suite 510, Los Angeles, CA, 90033, USA

    John C. Lipham

Authors
  1. James M. Tatum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Evan Alicuben
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nikolai Bildzukewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kamran Samakar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Caitlin C. Houghton
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John C. Lipham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John C. Lipham.

Ethics declarations

Disclosures

John C. Lipham and Nikolai Bildzukewicz are paid consultants for Torax Medical Corporation. James M. Tatum, Evan Alicuben, Kamran Samakar, and Caitlyn Houghton have no conflict conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tatum, J.M., Alicuben, E., Bildzukewicz, N. et al. Removing the magnetic sphincter augmentation device: operative management and outcomes. Surg Endosc 33, 2663–2669 (2019). https://doi.org/10.1007/s00464-018-6544-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6544-y

Keywords

Search

Navigation