How I do it: laparoscopic implantation of lower esophageal sphincter stimulator for the treatment of gastro-esophageal reflux disease

Abstract

: The principal medical treatment of gastro-esophageal reflux disease (GERD) is proton pump inhibitor (PPI) therapy. PPI lowers gastric acid secretion, but its long-term use is not free from adverse effects. However, PPI therapy has no effects on the dysfunctional lower esophageal sphincter (LES) and on reflux of stomach contents. Prior to the introduction of medical therapy, surgical gastric fundoplication was originally proposed in order to create a mechanical valve to prevent reflux. The postoperative results obtained after fundoplication depend on the surgical volume of the centers in which surgery is performed, and important functional sequelae, including dysphagia and gas bloat syndrome, have been reported. LES electrical stimulation therapy (EST) has been recently introduced as an alternative treatment option in the management of GERD. The rationale of this strategy is to electrically stimulate the LES in order to increase its tone and to reduce reflux. LES stimulator implantation is a feasible and safe minimally invasive technique. Data reported in the literature regarding the postoperative functional outcomes related to GERD, evaluated by 24 h-pH-manometry, and GERD specific questionnaire after the implantation of LES-EST, show significant improvement at both short and long-term follow up, up to three years after surgery. Although these data are encouraging, further prospective and randomized studies are required to draw definitive conclusions. We report the technique of laparoscopic LES stimulator surgical implantation, together with an explanatory video.