Laparoscopic insertion of a magnetic ring for gastro-oesophageal reflux disease

2.1 Gastro-oesophageal reflux disease (GORD) is a common condition in which acid from the stomach flows back up into the oesophagus. It is usually caused by the sphincter at the lower end of the oesophagus becoming weakened. Symptoms of GORD can be directly related to reflux episodes (such as heartburn, regurgitation, chest pain and nausea) or be caused by complications of the disease (such as dysphagia and respiratory difficulties). Repeated episodes of GORD can damage the lining of the oesophagus and lead to oesophageal ulceration, oesophageal stricture and Barrett's oesophagus.

2.2 NICE's guideline on GORD and dyspepsia in adults: investigation and management describes managing GORD in adults. The standard treatments for symptomatic GORD are lifestyle modification and drug therapy. People may be offered anti-reflux surgery (usually laparoscopic fundoplication) if their symptoms do not improve, or if they develop complications despite medication or they have an intolerance to medication. Endoscopic interventions (such as endoscopic radiofrequency ablation at the gastro‑oesophageal junction) and electrical stimulation of the lower oesophageal sphincter can also be used.

2.3 The aim of laparoscopic insertion of a magnetic ring for GORD is to relieve reflux-related symptoms (such as heartburn or regurgitation) without impeding the ability to swallow, belch or vomit.

2.4 The procedure is done under general anaesthesia. Using a laparoscopic approach, a specially designed sizing tool is placed around the distal oesophagus to assess the size of implant needed. The sizing tool is then removed, and the implant is placed at the gastro-oesophageal junction, with the posterior vagus nerve trunk located outside the magnetic ring. The ends of the implant are secured together to hold it in place. Intraoperative endoscopy may be used to help identify the anatomic gastro-oesophageal junction and to assess device position.

2.5 The implant consists of a ring of interlinked beads, each with a weak magnetic force that holds the beads together and reduces reflux. When the person swallows, the magnetic force is overcome, allowing the ring to open. After swallowing, magnetic attraction brings the beads together and the distal oesophagus is again closed.