Background

Utilization of magnetic sphincter augmentaiton (MSA) for the treatment of symptomatic acid reflux has become a common procedure. Gastroesophageal reflux disease, hiatal hernia and preoperative esophagitis are often contraindications when considering patients for sleeve gastrectomy or duodenal switch operations.

Methods

5 patients were identified during preoperative bariatric surgery evaluation who demonstrated significant gastroesophageal reflux and hiatal hernia on upper GI swallow. All patients required PPI therpay to control reflux symptoms. All patients underwent preoperative endoscopic evaluation and esophageal motility studies prior to placement of magnetic sphincter augmentation. Incidentally discovered and known hiatal hernias were repaired at the time of MSA placement. All patients underwent successfull MSA placement without complication. Postoperative upper GI swallow confirmed resolution of preoperative reflux findings in all patients. Patients were maintained on PPI therapy during the interval time between their MSA placement and their bariatric operation.

Results

All 5 patients completed the second stage to bariatric surgery. one patient underwent successful SADI, one patient decided to undergo RYGB and three patients underwent successful sleeve gastrecotmy. Postoperative upper GI swallow revealed the absence of any demonstratable hiatal hernia or reflux following bariatric srugery. All patients remained free of refllux symptoms. All patients were able to discontinue PPI therapy within 30 days of bariatric surgery.

Conclusions

Hiatal hernia and PPI dependent GERD might not necessarily be a contraindication to proceeding with sleeve gastrectomy or SADI in patients who are appropriate candidates for MSA. as a first stage operation prior to bariatric surgery.