Is magnetic sphincter augmentation a reasonable surgical option for gastroesophageal reflux disease?
The magnetic sphincter augmentation (MSA) procedure is a highly standardized laparoscopic surgical option for patients with well-documented gastroesophageal reflux disease who do not fully respond to medical treatment with proton-pump inhibitors (PPIs), complain of volume regurgitation, or develop progressive/refractory symptoms despite escalation therapy. The effectiveness of the MSA procedure has been proven in patients with typical reflux symptoms and PPI dependent who show an increased esophageal acid exposure on prolonged pH monitoring. Observational studies have demonstrated that MSA compares well with Nissen and Toupet laparoscopic fundoplication (LF) in selected patients, and has an acceptable risk profile. Whenever necessary, the MSA device can be explanted via laparoscopy without complications or long-term consequences, and a standard fundoplication can be concomitantly performed. Combining formal crural repair with MSA appears to strengthen the antireflux effect and reduce the need of reoperation. MSA represents a reasonable therapeutic option in patients with gastroesophageal reflux disease (GERD) and perhaps an alternative to LF.