Background

Magnetic sphincter augmentation (MSA) has been shown to be a safe and effective surgical option in treating medically refractory GERD. However, there is limited data evaluating the efficacy of this technique in patients with previous laparoscopic sleeve gastrectomy (LSG) and concurrent hiatal hernia. We present a novel case of managing GERD with laparoscopic MSA and hiatal hernia repair after LSG.

Methods

In September 2018, laparoscopic MSA and hiatal hernia repair was performed in a 58-year-old female with a DeMeester score of 51 who had undergone LSG 65 months prior. After repairing the hiatal hernia posteriorly, MSA was performed using a size 16 LINX® device. Patient demographic characteristics, operative details, and postoperative outcomes were collected and analyzed. Efficacy was evaluated using a previously validated GERD score questionnaire.

Results

Laparoscopic MSA was well tolerated without complications and the patient was discharged home within 24 hours. The severity and frequency of the patient’s reflux, regurgitation, epigastric pain, sensation of fullness, dysphagia, and cough symptoms were significantly improved postoperatively compared to preoperative evaluation with a reduction in the GERD score from 28 to 17.

Conclusions

Magnetic sphincter augmentation is a safe and effective surgical option for addressing medically refractory GERD in patients with a previous LSG and concurrent hiatal hernia.