Lower Esophageal Magnetic Sphincter Augmentation for Persistent Reflux After Roux-en-Y Gastric Bypass. 2016

Juan A Muñoz-Largacha, and Donald T Hess, and Virginia R Litle, and Hiran C Fernando
Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, 72 East Concord St., Boston, MA, 02118, USA. jamunoz@bu.edu.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a good option for the treatment of gastroesophageal reflux disease (GERD) in the obese population. However, some patients have significant reflux despite this procedure, and their treatment might be challenging. Laparoscopic lower esophageal magnetic sphincter augmentation (MSA) has been introduced into clinical practice with encouraging results. Currently, MSA is only approved for patients with hiatal hernias that are less than 3 cm and without history of antireflux procedures. We present two cases of MSA for the treatment of persistent GERD after LRYGB. Since this is an off-label use of this procedure, both patients underwent extensive evaluation before proceeding with surgery. Excellent results were obtained with a significant improvement in symptoms as well as their GERD Health-Related Quality of Life scores.

UI MeSH Term Description Entries
D008297 Male Males
D009767 Obesity, Morbid The condition of weighing two, three, or more times the ideal weight, so called because it is associated with many serious and life-threatening disorders. In the BODY MASS INDEX, morbid obesity is defined as having a BMI greater than 40.0 kg/m2. Morbid Obesity,Obesity, Severe,Morbid Obesities,Obesities, Morbid,Obesities, Severe,Severe Obesities,Severe Obesity
D010535 Laparoscopy A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy. Celioscopy,Laparoscopic Surgical Procedures,Peritoneoscopy,Surgical Procedures, Laparoscopic,Laparoscopic Assisted Surgery,Laparoscopic Surgery,Laparoscopic Surgical Procedure,Procedure, Laparoscopic Surgical,Procedures, Laparoscopic Surgical,Surgery, Laparoscopic,Surgical Procedure, Laparoscopic,Celioscopies,Laparoscopic Assisted Surgeries,Laparoscopic Surgeries,Laparoscopies,Peritoneoscopies,Surgeries, Laparoscopic,Surgeries, Laparoscopic Assisted,Surgery, Laparoscopic Assisted
D005260 Female Females
D005764 Gastroesophageal Reflux Retrograde flow of gastric juice (GASTRIC ACID) and/or duodenal contents (BILE ACIDS; PANCREATIC JUICE) into the distal ESOPHAGUS, commonly due to incompetence of the LOWER ESOPHAGEAL SPHINCTER. Esophageal Reflux,Gastro-Esophageal Reflux Disease,GERD,Gastric Acid Reflux,Gastric Acid Reflux Disease,Gastro-Esophageal Reflux,Gastro-oesophageal Reflux,Gastroesophageal Reflux Disease,Reflux, Gastroesophageal,Acid Reflux, Gastric,Gastro Esophageal Reflux,Gastro Esophageal Reflux Disease,Gastro oesophageal Reflux,Gastro-Esophageal Reflux Diseases,Reflux Disease, Gastro-Esophageal,Reflux, Gastric Acid,Reflux, Gastro-Esophageal,Reflux, Gastro-oesophageal
D006551 Hernia, Hiatal STOMACH herniation located at or near the diaphragmatic opening for the ESOPHAGUS, the esophageal hiatus. Hernia, Esophageal,Hernia, Paraesophageal,Hiatal Hernia,Esophageal Hernia,Hernia, Hiatus,Paraesophageal Hiatal Hernia,Sliding Esophageal Hernia,Sliding Hiatal Hernia,Esophageal Hernia, Sliding,Esophageal Hernias,Esophageal Hernias, Sliding,Hernia, Paraesophageal Hiatal,Hernia, Sliding Esophageal,Hernia, Sliding Hiatal,Hernias, Esophageal,Hernias, Hiatal,Hernias, Hiatus,Hernias, Paraesophageal,Hernias, Paraesophageal Hiatal,Hernias, Sliding Esophageal,Hernias, Sliding Hiatal,Hiatal Hernia, Paraesophageal,Hiatal Hernia, Sliding,Hiatal Hernias,Hiatal Hernias, Paraesophageal,Hiatal Hernias, Sliding,Hiatus Hernia,Hiatus Hernias,Paraesophageal Hernia,Paraesophageal Hernias,Paraesophageal Hiatal Hernias,Sliding Esophageal Hernias,Sliding Hiatal Hernias
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D015390 Gastric Bypass Surgical procedure in which the STOMACH is transected high on the body. The resulting small proximal gastric pouch is joined to any parts of the SMALL INTESTINE by an end-to-side SURGICAL ANASTOMOSIS, depending on the amounts of intestinal surface being bypasses. This procedure is used frequently in the treatment of MORBID OBESITY by limiting the size of functional STOMACH, food intake, and food absorption. Gastroileal Bypass,Gastrojejunostomy,Greenville Gastric Bypass,Roux-en-Y Gastric Bypass,Bypass, Gastric,Bypass, Gastroileal,Bypass, Roux-en-Y Gastric,Gastric Bypass, Greenville,Gastric Bypass, Roux-en-Y,Gastrojejunostomies,Roux en Y Gastric Bypass
D049630 Esophageal Sphincter, Lower The physiologic or functional barrier to GASTROESOPHAGEAL REFLUX at the esophagogastric junction. Sphincteric muscles remain tonically contracted during the resting state and form the high-pressure zone separating the lumen of the ESOPHAGUS from that of the STOMACH. (Haubrich et al, Bockus Gastroenterology, 5th ed., pp399, 415) Lower Esophageal Sphincter,Gastroesophageal Sphincter,Gastroesophageal Sphincters,Sphincter, Gastroesophageal,Sphincter, Lower Esophageal

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