title: Surgical Technique for Laparoscopic Removal of a Magnetic Lower Esophageal Sphincter Augmentation Device.
abstract: BACKGROUND
  Nissen fundoplication is the current gold standard for surgical management of gastroesophageal reflux disease; however, a magnetic antireflux device is now an alternative surgical procedure. The early literature shows good reflux control with minimal complications, and therefore placement of these devices is growing in popularity. As more of these devices are placed, there will be cases in which they will need to be removed. A laparoscopic method for removing the device is presented here.
  
  
  METHODS
  We present a case of a 42-year-old female with history of gastroesophageal reflux who underwent a laparoscopic placement of a magnetic lower esophageal sphincter augmentation device and repair of a small hiatal hernia. She had a complicated postoperative course before presenting to our institution with a 2-year history of persistent dysphagia and requesting the device be removed. Laparoscopic removal of the device was performed.
  
  
  RESULTS
  After laparoscopic removal of the patient's magnetic lower esophageal sphincter augmentation device, she had subjective improvement in her dysphagia but is now being medically managed for gastroesophageal reflux and for delayed gastric emptying.
  
  
  CONCLUSIONS
  Laparoscopic removal of magnetic lower esophageal sphincter augmentation devices will sometimes be necessary and may be challenging if the surgeon encounters significant scar tissue around the gastroesophageal junction. Postoperative complications are similar to those encountered with foregut surgeries and include postoperative delayed gastric emptying.
authors.affiliation: Division of General and Gastrointestinal Surgery, Emory University , Atlanta, Georgia .
authors.forename: Jamil L
authors.initials: JL
authors.lastname: Stetler
authors.affiliation: Division of General and Gastrointestinal Surgery, Emory University , Atlanta, Georgia .
authors.forename: Sujata
authors.initials: S
authors.lastname: Gill
authors.affiliation: Division of General and Gastrointestinal Surgery, Emory University , Atlanta, Georgia .
authors.forename: Ankit
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of General and Gastrointestinal Surgery, Emory University , Atlanta, Georgia .
authors.forename: S Scott
authors.initials: SS
authors.lastname: Davis
authors.affiliation: Division of General and Gastrointestinal Surgery, Emory University , Atlanta, Georgia .
authors.forename: Edward
authors.initials: E
authors.lastname: Lin
mesh_terms: D000328:Adult; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D020878:Device Removal / Q000379:methods*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D059346:Magnets; D011183:Postoperative Complications / Q000601:surgery*