380 Laparoscopic Magnetic Sphincter Augmentation (LINX) for Medically Refractory GORD: A Case-Based Video Demonstration

Abstract Background Laparoscopic Magnetic Sphincter Augmentation (MSA) has been acknowledged by NICE as an alternative approach to fundoplication for treatment of Gastro-oesophageal Reflux Disease (GORD). We present a case demonstrating surgical technique, decision-making, and long-term outcome. Case Presentation A 37-year-old male with a 5-year history of GORD symptoms—heartburn and regurgitation—was referred for surgical intervention. He was intolerant of proton pump inhibitors and managed with cimetidine. Preoperative work-up showed normal oesophageal motility and a DeMeester score of 35 on 24-hour pH monitoring. OGD revealed no visible hiatus hernia and a lax gastro-oesophageal junction (LA grade A oesophagitis). Intraoperative Findings & Technique Laparoscopy revealed a small (3 cm) sliding hiatus hernia. Key steps included crural dissection, mobilisation of the oesophagus, and primary hiatus hernia repair using interrupted Ethibond sutures. The vagus nerve were identified and preserved. A tunnel was created posterior to the oesophagus at the GOJ, the oesophageal circumference was measured using a sizing tool, and a size 16 LINX device was implanted. Outcome Initial postoperative recovery was uneventful with resolution of reflux symptoms. At 1-year follow-up, the patient reported persistent dysphagia. OGD showed no recurrence of hernia, the LINX device in situ, and mild resistance to endoscope passage. The lower oesophageal sphincter was dilated to 18 mm using a through-the-scope (TTS) balloon, with symptom improvement thereafter. Conclusion This case highlights the utility of LINX in selected GORD patients and discusses management of persistent postoperative dysphagia.