Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University , of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
Department of Medicine and Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy.
Langenbecks Arch Surg. 2021 Nov;406(7):2545-2551. doi: 10.1007/s00423-021-02294-7. Epub 2021 Aug 30.
The magnetic sphincter augmentation (MSA) device has become a common option for the treatment of gastroesophageal reflux disease (GERD). Knowledge of MSA-related complications, indications for removal, and techniques are puzzled. With this study, we aimed to evaluate indications, techniques for removal, surgical approach, and outcomes with MSA removal.
This is an observational singe-center study. Patients were followed up regularly with endoscopy, pH monitoring, and assessed for specific gastroesophageal reflux disease health-related quality of life (GERD-HRQL) and generic short-form 36 (SF-36) quality of life.
Five patients underwent MSA explant. Four patients were males and the median age was 47 years (range 44-55). Heartburn, epigastric/chest pain, and dysphagia were commonly reported. The median implant duration was 46 months (range 31-72). A laparoscopic approach was adopted in all patients. Intraoperative findings included normal anatomy (40%), herniation in the mediastinum (40%), and erosion (20%). The most common anti-reflux procedures were Dor (n = 2), Toupet (n = 2), and anterior partial fundoplication (n = 1). The median operative time was 145 min (range 60-185), and the median hospital length of stay was 4 days (range 3-6). The median postoperative follow-up was 41 months (range 12-51). At the last follow-up, 80% of patients were off PPI; the GERD-HRQL and SF-36 questionnaire were improved with DeMeester score and esophageal acid exposure normalization.
The MSA device can be safely explanted through a single-stage laparoscopic procedure. Tailoring a fundoplication, according to preoperative patient symptoms and intraoperative findings, seems feasible and safe with a promising trend toward improved symptoms and quality of life.
磁括约肌增强（MSA）装置已成为治疗胃食管反流病（GERD）的常用选择。人们对 MSA 相关并发症、移除指征和技术存在困惑。本研究旨在评估 MSA 移除的适应证、移除技术、手术途径和结果。
这是一项观察性单中心研究。患者定期接受内镜检查、pH 监测，并评估特定的胃食管反流病健康相关生活质量（GERD-HRQL）和通用简式 36 项健康调查量表（SF-36）生活质量。
5 例患者接受了 MSA 摘除。4 例为男性，中位年龄为 47 岁（范围 44-55 岁）。烧心、上腹痛/胸痛和吞咽困难是常见的报告症状。植入中位时间为 46 个月（范围 31-72 个月）。所有患者均采用腹腔镜入路。术中发现包括正常解剖结构（40%）、纵隔疝（40%）和侵蚀（20%）。最常见的抗反流手术方式为 Dor（n=2）、Toupet（n=2）和前部分胃底折叠术（n=1）。中位手术时间为 145 分钟（范围 60-185 分钟），中位住院时间为 4 天（范围 3-6 天）。中位术后随访时间为 41 个月（范围 12-51 个月）。末次随访时，80%的患者停用了 PPI；DeMeester 评分和食管酸暴露正常化使 GERD-HRQL 和 SF-36 问卷得到改善。
MSA 装置可通过单阶段腹腔镜手术安全摘除。根据术前患者症状和术中发现定制胃底折叠术是可行且安全的，具有改善症状和生活质量的良好趋势。
