43285 Removal of esophageal sphincter augmentation device

Name of the Procedure:

Removal of Esophageal Sphincter Augmentation Device (also known as Magnetic Sphincter Augmentation Device Removal)

Summary

This procedure involves the removal of a device that was previously implanted around the lower esophageal sphincter (LES) to help control gastroesophageal reflux disease (GERD). The device, typically a ring of magnetic beads, aims to enhance the function of the LES but may need to be removed for various reasons like complications or failure to alleviate symptoms.

Purpose

• Medical Condition: Mainly addresses complications or failure associated with an esophageal sphincter augmentation device.
• Goals: To alleviate symptoms or adverse reactions caused by the implanted device and restore normal esophageal function.

Indications

• Persistent GERD symptoms despite the device.
• Complications like difficulty swallowing (dysphagia), pain, or device erosion.
• Patient preference for removal.
• Device malfunction or migration.

Preparation

• Fasting: Patient may be required to fast 6-8 hours before the procedure.
• Medication Adjustments: Certain medications, particularly blood thinners, might need to be adjusted.
• Assessments: Pre-operative diagnostic evaluations including endoscopy or imaging studies to assess the current state of the device and esophagus.

Procedure Description

1. Anesthesia: The patient is usually given general anesthesia.
2. Incision: A small incision is made, often laparoscopically, to access the device.
3. Device Removal: The surgeon carefully locates and frees the augmentation device from the LES.
4. Inspection: Surrounding tissues are inspected for any damage or complications.
5. Closure: The incision is closed, typically with sutures.

Duration

The procedure usually takes about 1 to 3 hours, depending on the complexity and the patient’s condition.

Setting

This procedure is generally performed in a hospital or surgical center equipped with the necessary facilities for laparoscopic surgery.

Personnel

• Surgeon: Typically a specialist in gastrointestinal or thoracic surgery.
• Nurses: Assist with pre-operative preparation, intra-operative support, and post-operative care.
• Anesthesiologist: Manages anesthesia and monitors the patient’s vital signs.

Risks and Complications

• Common Risks: Infection, bleeding, adverse reaction to anesthesia.
• Rare Risks: Damage to the esophagus or stomach, persistent GERD symptoms, injury to surrounding organs, migration of the device causing complications.

Benefits

• Relief from complications such as dysphagia and pain.
• Potential improvement in GERD symptoms if the device was not functioning correctly.
• Restoration of normal swallowing and esophageal function.

Recovery

• Post-Procedure Care: Monitoring in a recovery room, possibly an overnight hospital stay.
• Instructions: Gradual reintroduction to normal diet, wound care instructions, and activity restrictions.
• Recovery Time: Typically a few days to a week to resume normal activities.
• Follow-Up: Scheduled appointments to monitor recovery and resolution of symptoms.

Alternatives

• Medications: Proton pump inhibitors or H2 blockers for managing GERD.
• Surgical Options: Fundoplication surgery, which reinforces the LES.
• Pros and Cons: Medications are less invasive but may not be effective long-term; surgical alternatives may provide a more permanent solution but carry surgical risks.

Patient Experience

• During the Procedure: The patient will be under general anesthesia and should not feel anything.
• Post-Procedure: The patient might experience some pain at the incision site, mild discomfort from bloating or gas, and temporary difficulty swallowing. Pain management includes prescribed pain medications and comfort measures.