Name of the Procedure:

Laparoscopy, Surgical, Esophageal Sphincter Augmentation Procedure, Placement of Sphincter Augmentation Device (i.e., Magnetic Band), Including Cruroplasty When Performed.

Summary

Laparoscopy for esophageal sphincter augmentation involves using minimally invasive techniques to place a magnetic band around the esophagus to help treat acid reflux by strengthening the lower esophageal sphincter (LES). This can also include cruroplasty, which repairs the diaphragmatic hiatus if necessary.

Purpose

This procedure addresses gastroesophageal reflux disease (GERD), a condition where stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). The goal is to prevent acid reflux, alleviate symptoms such as heartburn, and improve quality of life.

Indications

• Persistent GERD symptoms not controlled by medication.
• Severe esophagitis.
• Chronic cough or laryngitis related to reflux.

• Patients who do not want lifelong medication.

  Preparation

• Patients may need to fast (no eating or drinking) for 8 hours before the procedure.
• Adjustments or temporary discontinuation of certain medications might be required.
• Pre-operative assessment may include an upper endoscopy, pH monitoring, and manometry.

Procedure Description

1. The patient is given general anesthesia.
2. Small incisions are made in the abdomen.
3. A laparoscope (a thin tube with a camera) is inserted to view the esophagus and stomach.
4. The surgeon places a magnetic band around the LES.
5. If needed, cruroplasty is performed to repair the diaphragm.
6. Incisions are closed, and the patient is taken to recovery.

Duration

The procedure typically takes about 1-2 hours.

Setting

It is usually performed in a hospital or surgical center in an operating room.

Personnel

A multidisciplinary team including:

• Surgeon
• Surgical nurses
• Anesthesiologist
• Operating room technicians

Risks and Complications

Common risks include:

• Infection
• Bleeding

• Reaction to anesthesia

  Rare complications might include:

• Band erosion or migration
• Difficulty swallowing

• Gas bloating syndrome

  Benefits

• Reduction or elimination of GERD symptoms.
• Minimized need for medication.
• Improved quality of life may be noticed in days to weeks after the procedure.

Recovery

• Hospital stay of 1-2 days might be required.
• Gradual return to normal diet, starting with liquids and progressing to solids.
• Avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments to monitor recovery and device function.

Alternatives

• Medication therapy (e.g., proton pump inhibitors, H2 blockers).
• Traditional fundoplication surgery.
• Lifestyle and dietary changes. Advantages of laparoscopic sphincter augmentation include being less invasive and reversible compared to traditional surgery.

Patient Experience

During the procedure, patients are under general anesthesia and will feel no pain. Post-procedure, they may experience some discomfort or pain at the incision sites and mild nausea, which can be managed with medication. Gradual dietary and activity modifications will help in recovery.