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SEVERE DYSPHAGIA FOLLOWING MAGNETIC SPHINCTER AUGMENTATION: A CASE REPORT
Abdul Subhan Talpur
*2, Ibrar Atiq
2, Hammad Qadri
2, Mustafa Sajjad Cheema
1, marwa mahjoub
2, Yasir Ahmed
21CMH Lahore Medical College and Institute of Dentistry, Lahore, Punjab, Pakistan; 2UHS Wilson Medical Center, Johnson CIty, NY
Introduction: Gastro-esophageal reflux disease (GERD) is a common digestive disorder, characterized by a wide range of clinical manifestations, a morbidity that is not widely recognized, and significant economic repercussions. GERD is usually managed with medications. However, surgical interventions, such as Fundoplication, and magnetic sphincter augmentation (LINX), provide an alternative for patients who are experiencing symptoms that are resistant to medication or who are intolerable to medication. In this case report, we will discuss a rare case of severe post-LINX complications that can cause significant morbidity, and require device removal, despite its innovative approach.
Clinical Presentation: A 40-year-old woman had morbid obesity (post-rGBS), hypertension, mitral valve prolapse, refractory GERD, and hiatal hernia. Medical treatment for her GERD symptoms failed, prompting surgery. Solid phase esophagogram showed effective esophageal motility, clearing bagel and marshmallow boluses without Barrett's esophagitis or structural abnormalities. Thus, GERD with hiatal hernia was diagnosed. The patient's laparoscopic hiatal hernia repair and LINX magnetic sphincter augmentation procedure took place on December 9, 2020.
Course and Complications Following Surgery: GERD patients with hiatal hernia repairs and LINX placement had severe abdominal pain immediately after eating and early satiety. The patient had constipation despite Relistor and stool softeners. The patient developed progressive solid food dysphagia, a LINX complication. GERD symptoms did not improve with lansoprazole twice daily and Pepcid at bedtime. Esophageal studies show persistent reflux in a recumbent position and food retention proximal to the LINX device, suggesting functional obstruction. The patient had LINX removed surgically on June 2, 2022, due to severe and persistent symptoms.
Discussion: LINX device complications in refractory GERD patients are highlighted in this case. Patients with prior bariatric surgery, altered anatomy, or motility disorders can undergo LINX surgery. LINX improves the lower esophageal sphincter, but complications include dysphagia, functional obstruction, and anti-reflux failure can be seen. Progressive dysphagia, postprandial pain, and early satiety necessitated LINX removal. Detecting complications early reduces long-term morbidity. This case emphasizes the need to weigh surgical benefits and risks for GERD patients with complex anatomical or clinical profiles.
Conclusion: The LINX procedure is one of the GERD treatments. We must balance disease management with awareness of treatment-related complications, which can significantly impact patient outcomes, as shown in this case. To maximize the benefits of this promising intervention, more research is needed to improve patient selection criteria, procedural safety, and adverse event risk.
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