SSAT Home  |  Past Meetings
Society for Surgery of the Alimentary Tract

Back to 2022 Abstracts


A MULTICENTER EVALUATION OF FACTORS ASSOCIATED WITH MAGNETIC SPHINCTER AUGMENTATION DEVICE REMOVAL
Jack P. Silva*1, Charles Hill2, Mark C. Wang1, Eddie A. Rodriguez1, Derek J. Yan2, Jessica Wu1, Luke R. Putnam1, Caitlin C. Houghton1, Nikolai A. Bildzukewicz1, F. P. Buckley2, John C. Lipham1
1University of Southern California, Los Angeles, CA; 2Dell Seton Medical Center at The University of Texas, Austin, TX

Introduction:
Following FDA approval in 2012, magnetic sphincter augmentation (MSA) has been performed with excellent outcomes. However, the MSA device does require removal occasionally due to dysphagia, erosion, or ongoing reflux. Patient and perioperative factors associated with device removal have not been well described, so this study sought to analyze demographic and surgical variables which may influence MSA removal.
Methods:
This is a multicenter retrospective review of patients who underwent MSA and subsequent device removal from 2013-2021. Demographics, comorbidities, surgical details, and postoperative outcomes were collected. Patients with device removal were compared to those without removal using student's t test for continuous variables and chi-squared analysis for categorical variables.
Results:
At one center, 750 devices were implanted, of which 58 were removed (7.7%). When including device removals from the second participating center, 79 patients underwent MSA device removal. All removals were performed laparoscopically and at a mean time of 25 +/- 13 months after implantation. Removal patients were younger (56 vs 60 years, P=0.01), had smaller devices (14 vs 15 beads, P<0.01), longer implant operative time (77 vs 62 minutes, P<0.01) and were more likely to have autoimmune disease (21% vs 6%, P<0.01). Of patients requiring removal, 41% had a diagnosis of anxiety or depression. The reasons for removal were dysphagia (60%), chest pain (12%), erosion (5.2%), or other (22%). There were no postoperative complications after MSA removal.
Conclusion:
The most common reason for removal is dysphagia followed by chest pain and very rarely for device erosion. In all cases, removal is safe and not associated with adverse outcomes. Patients with existing autoimmune disease, anxiety, or depression may have a higher likelihood of eventual device removal. Historical use of smaller MSA devices associated with higher removal rates may explain recent practice changes to upsize by one bead size on initial device placement.



Back to 2022 Abstracts