Magnetic surgery for lower esophageal sphincter augmentation: two decades of research and innovation

Gastroesophageal reflux disease (GERD) exhibits a significant prevalence within the Western demographic, wherein approximately 30% of individuals report symptoms associated with reflux. Magnetic sphincter augmentation (MSA) is a standardized laparoscopic intervention initially designed for patients who are not satisfied with pharmacologic management and for those diagnosed with early-stage GERD who may not qualify as optimal candidates for fundoplication surgery. The MSA device is designed to encircle the esophagogastric junction and enhance the natural anti-reflux barrier through the application of magnetic force without causing mechanical compression. MSA, particularly when performed in conjunction with crural reinforcement, has demonstrated significant efficacy in alleviating symptoms of GERD, reducing dependence from proton-pump inhibitors, diminishing esophageal acid exposure, and enhancing patients' overall quality of life. Safety concerns like erosion and migration occur infrequently and are not linked to mortality. This surgical intervention is reversible, allowing for laparoscopic removal of the device if deemed necessary. A potential limitation of the MSA procedure lies in its contraindication for patients undergoing imaging in high-field strength Tesla magnetic resonance systems. Understanding the physiology of the MSA implant and selecting patients based on the GERD phenotype are critical for improving the long-term outcomes of the procedure. Individualizing the choice of the operative technique in GERD patients has the potential to increase acceptance of the surgical procedure and reduce the burden of the disease. • Clinical utilization of Magnetic Sphincter Augmentation (MSA) for the treatment of GERD has undergone progressive development over time. Nonetheless, there remains a paucity of evidence concerning predictors of treatment success and long-term outcomes. • A comprehensive understanding of esophageal physiology, coupled with the implementation of an appropriate management protocol within a multidisciplinary framework, is pivotal for achieving satisfactory clinical results. • Personalization of GERD surgery with innovative procedures has the potential to meet patient’s expectations and fill the current therapeutic gap between medical and surgical therapy.