Removal of the Magnetic Sphincter Augmentation Device Surgical Technique and Results of a Single-center Cohort Study

被引:49
作者
Asti, Emanuele [1 ]
Siboni, Stefano [1 ]
Lazzari, Veronica [1 ]
Bonitta, Gianluca [1 ]
Sironi, Andrea [1 ]
Bonavina, Luigi [1 ]
机构
[1] Univ Milan, Div Gen Surg, Dept Biomed Sci Hlth, Milan, Italy
关键词
fundoplication; gastroesophageal reflux disease; laparoscopic antireflux surgery; magnetic sphincter augmentation device; GASTROESOPHAGEAL-REFLUX; EXPERIENCE;
D O I
10.1097/SLA.0000000000001785
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: The aim of this study was to identify patients' characteristics that may predict failure and removal of the Linx sphincter augmentation device, and to report the results of 1-stage laparoscopic removal and fundoplication. Background: The Linx device is a long-term magnetic implant that was developed as a less disruptive and more reproducible surgical option for patients with early-stage gastroesophageal reflux disease (GERD). Removal of the device has been shown to be feasible, but no long-term results of this procedure have been reported yet. Methods: A review of the prospectively collected research database of antireflux surgery was performed to identify all patients who underwent a Linx implant between 2007 and 2015 in our Institution. Demographics, duration of symptoms and proton pump inhibitor (PPI) therapy, GERD-Health Related Quality of Life scores, esophageal acid exposure, lower esophageal sphincter pressure, number of beads (size) of the implanted device, concurrent crura repair, angle of inclination of the device at postoperative chest film, operative time, postoperative complications, and length of stay were recorded. Data of the explanted patients were compared with those with the device in situ in an attempt to identify factors associated with Linx removal. Results: Over the study period, 164 patients underwent a laparoscopic Linx implant and had a median follow-up of 48 months [interquartile range (IQR) 36]. Eleven (6.7%) of these patients were explanted at a later date. The estimated removal-free probability at 80 months was 0.91 [confidence interval (CI) 0.86-0.96]. Supine esophageal acid exposure before the index operation was associated with Linx removal (odds ratio 1.05, CI 1.01-1.11, P = 0.037). The main presenting symptom requiring device removal was recurrence of heartburn or regurgitation in 5 patients (46%), followed by dysphagia (n = 4, 37%) and chest pain (n = 2, 18%). In 2 patients, full-thickness erosion of the esophageal wall with partial endoluminal penetration of the device occurred. The median implant duration was 20 months, with 82% of the patients being explanted between 12 and 24 months after the implant. Device removal was most commonly combined with partial fundoplication. There were no conversions to laparotomy and the postoperative course was uneventful in all patients. At the latest follow-up, ranging from 12 to 58 months, the GERD-HRQL score was within normal limits in all patients. Conclusions: Laparoscopic removal of the Linx device can be safely performed as a 1-stage procedure and in conjunction with fundoplication even in patients presenting with device erosion.
引用
收藏
页码:941 / 945
页数:5
相关论文
共 13 条
[1]   Endoluminal perforation of a magnetic antireflux device [J].
Bauer, Margit ;
Meining, Alexander ;
Kranzfelder, Michael ;
Jell, Alissa ;
Schirren, Rebekka ;
Wilhelm, Dirk ;
Friess, Helmut ;
Feussner, Hubertus .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2015, 29 (12) :3806-3810
[2]   One Hundred Consecutive Patients Treated with Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease: 6 Years of Clinical Experience from a Single Center [J].
Bonavina, Luigi ;
Saino, Greta ;
Bona, Davide ;
Sironi, Andrea ;
Lazzari, Veronica .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2013, 217 (04) :577-585
[3]   Laparoscopic Sphincter Augmentation Device Eliminates Reflux Symptoms and Normalizes Esophageal Acid Exposure One- and 2-Year Results of a Feasibility Trial [J].
Bonavina, Luigi ;
DeMeester, Tom ;
Fockens, Paul ;
Dunn, Daniel ;
Saino, Greta ;
Bona, Davide ;
Lipham, John ;
Bemelman, Willem ;
Ganz, Robert A. .
ANNALS OF SURGERY, 2010, 252 (05) :857-862
[4]   Magnetic Augmentation of the Lower Esophageal Sphincter: Results of a Feasibility Clinical Trial [J].
Bonavina, Luigi ;
Saino, Greta I. ;
Bona, Davide ;
Lipham, John ;
Ganz, Robert A. ;
Dunn, Daniel ;
DeMeester, Tom .
JOURNAL OF GASTROINTESTINAL SURGERY, 2008, 12 (12) :2133-2140
[5]   Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients [J].
Di Lorenzo, Nicola ;
Lorenzo, Michele ;
Furbetta, Francesco ;
Favretti, Franco ;
Giardiello, Cristiano ;
Boschi, Sergio ;
Alfredo, Genco ;
Micheletto, Giancarlo ;
Borrelli, Vincenzo ;
Veneziani, Augusto ;
Lucchese, Marcello ;
Boni, Marcello ;
Civitelli, Simona ;
Camperchioli, Ida ;
Pilone, Vincenzo ;
De Luca, Maurizio ;
De Meis, Paolo ;
Cipriano, Massimiliano ;
Paganelli, Michele ;
Mancuso, Vincenzo ;
Gardinazzi, Angelo ;
Schettino, Angelo ;
Maselli, Roberta ;
Forestieri, Pietro .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2013, 27 (04) :1151-1157
[6]   Long-term Outcomes of Patients Receiving a Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux [J].
Ganz, Robert A. ;
Edmundowicz, Steven A. ;
Taiganides, Paul A. ;
Lipham, John C. ;
Smith, C. Daniel ;
DeVault, Kenneth R. ;
Horgan, Santiago ;
Jacobsen, Garth ;
Luketich, James D. ;
Smith, Christopher C. ;
Schlack-Haerer, Steven C. ;
Kothari, Shanu N. ;
Dunst, Christy M. ;
Watson, Thomas J. ;
Peters, Jeffrey ;
Oelschlager, Brant K. ;
Perry, Kyle A. ;
Melvin, Scott ;
Bemelman, Willem A. ;
Smout, Andre J. P. M. ;
Dunn, Dan .
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 2016, 14 (05) :671-677
[7]   Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease [J].
Lipham, J. C. ;
Taiganides, P. A. ;
Louie, B. E. ;
Ganz, R. A. ;
DeMeester, T. R. .
DISEASES OF THE ESOPHAGUS, 2015, 28 (04) :305-311
[8]  
Miholic J, 2013, NEW ENGL J MED, V368, P2038, DOI [10.1056/NEJMoa1205544, 10.1056/NEJMc1303656]
[9]  
Pournelle G. H., 1953, Journal of Mammalogy, V34, P133, DOI 10.1890/0012-9658(2002)083[1421:SDEOLC]2.0.CO
[10]  
2