BN SO27 - Articulative Minimally Invasive Surgery and Placement of Anti-reflux Magnetic Surgical Appliance (LINX)

Abstract Background Gastro-oesophageal reflux disease (GORD) is a condition of prolonged retrograde flow of gastric contents into the oesophagus or structures beyond, causing symptoms such as heartburn and regurgitation.1 Laparoscopic Nissen Fundoplication (LNF) has been the surgical gold standard, however its side effects and technical challenges has limited its use to 1% of the GERD population.2 The use of a magnetic surgical appliance (LINX) has recently emerged as a promising treatment in overcoming the limitations of conventional LNF.3 Literature has shown patients aged less than 45 with satisfactory mean contraction amplitude (MAP) of 30mmHg and typical symptoms have favourable outcomes with LINX.3 Method This is a case of a 35-year-old patient presenting with typical reflux symptoms, with satisfactory MAP and high DeMeester score, patulous gastro-oesophageal junction and no hiatus hernia endoscopically. Steps for LINX placement are described in the video and we demonstrate the use of ArtiSential, an articulating laparoscopic instrument that provides better range of motion and angulation comparable to that of a robotic instrument. Results Using a magnetic surgical appliance (LINX) is superior to LNF through preservation of physiological belching and vomiting, reducing surgical time and duration of hospital stay while also scoring highly on quality of life and patient satisfaction.4 Conclusion We would recommend considering the placement of a LINX device in suitable patients as it provides good outcomes on par with LNF and to consider the use of an articulating instrument (ArtiSential) as it provides the surgeon better control and ease in placing a small device laparoscopically.