Background

Gastroesophageal reflux (GERD) after sleeve gastrectomy is relatively common and conversion to gastric bypass is sometimes required to alleviate symptoms. Primary magnetic sphincter augmentation (MSA) is a viable alternative to fundoplication in select patients with GERD. A 2015 case report proposed MSA as a safe option for treating GERD after sleeve gastrectomy. The purpose of the current study is to compare efficacy and safety between patients with primary MSA and MSA after sleeve gastrectomy.

Methods

A retrospective, single-center, review was conducted for patients undergoing MSA or MSA after sleeve gastrectomy from 2018-2023. Pre- and post-operative usage of proton pump inhibitors (PPI) was compared between primary MSA and MSA after sleeve groups. Incidence of post-operative complications was also compared.

Results

67 patients met inclusion criteria (49 primary MSA, 18 MSA over sleeve). Mean follow up was 393 days. Mean body mass index, age, device size, and sex distribution were similar between the 2 groups. There was no significant difference in postoperative PPI requirement between patients with MSA versus MSA over sleeve (27.3 vs. 31.3%, p=0.756). Incidence of postoperative dysphagia (28.6 vs 22.2%), recurrent paraesophageal hernia (4.1 vs 5.6%), and endoscopic dilation (14.3 vs 11.1%) was similar between groups. The rate of device explantation was higher in the primary MSA group although not significant (12.2 vs. 5.6%, p=0.664).

Conclusions

MSA over sleeve is similarly efficacious to primary MSA in decreasing PPI requirements postoperatively. It has a similar safety profile to primary MSA and rate of device explantation appears to be lower.