Abstract
PurposeThe development of gastroesophageal reflux disease (GERD) has been shown to be not infrequent after laparoscopic sleeve gastrectomy (LSG). Management may vary from medical therapy to Roux-en-Y gastric bypass (RYGB) conversion. Magnetic sphincter augmentation (MSA) device has been shown to be a promising option with excellent results. The purpose of this video was to demonstrate the laparoscopic management of post-LSG GERD with MSA device implant.Materials and MethodsAn intraoperative video has been edited to demonstrate the MSA device placement after LSG for the treatment of pathologic GERD.ResultsThe procedure started with the lysis of the perigastric adhesions to free the distal esophagus circumferentially. The posterior vagus nerve was identified, and a small window was created between the posterior esophageal wall anteriorly and the vagus nerve posteriorly. A hiatoplasty was performed using two non-resorbable interrupted 2.0 Prolene® sutures. The system’s sizer was placed to measure the junctional circumference. A 15-mm MSA device was implanted.ConclusionMSA device placement seems technically feasible and safe with promising results in term of improved LES resting pressure and esophageal acid exposure. While future studies are necessary to corroborate these preliminary indications, MSA device may possibly become a valid option in surgeon armamentarium.
Highlights
Laparoscopic sleeve gastrectomy (LSG) has gained progressive worldwide acceptance [1]
As the number of patients with post-laparoscopic sleeve gastrectomy (LSG) gastroesophageal reflux disease (GERD) will grow in the future because the increasing number of performed procedures, Magnetic sphincter augmentation (MSA) device implant may constitute an attractive option in surgeon armamentarium
The use of MSA for the treatment of post-LSG GERD has been described in previous studies [10–12]
Summary
1. The development of “de novo” or the worsening of latent preoperative gastroesophageal reflux disease (GERD) has been shown to be not infrequent after laparoscopic sleeve gastrectomy (LSG). 2. Comprehensive assessment and objective evaluation with upper endoscopy, high-resolution manometry and 24-h pH-impedance study are recommended in patients with GERD symptoms after LSG. 3. As the number of patients pathologic GERD after LSG will grow in the future because the increasing number of worldwide performed procedures, laparoscopic MSA device implant may be an attractive and promising option in the surgeon armamentarium
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