• Emanuele Asti, Alberto Aiolfi, Veronica Lazzari, Andrea Sironi, Matteo Porta, and Luigi Bonavina.
• Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milano, Milan, Italy.
• Updates Surg. 2018 Sep 1; 70 (3): 323-330.

AbstractUse of the magnetic sphincter augmentation (MSA) device for the laparoscopic treatment of gastroesophageal reflux disease is increasing since the first clinical implant performed a decade ago. The MSA procedure is a minimally invasive and highly standardized surgical option for patients who are partially responders to proton-pump inhibitors, which have troublesome regurgitation or develop progressive symptoms despite continuous medical therapy. The procedure has proven to be highly effective in improving typical reflux symptoms, reducing the use of proton-pump inhibitors, and decreasing esophageal acid exposure. Observational cohort studies have shown that MSA compares well with fundoplication in selected patients and has an acceptable safety profile. The device can be easily removed if necessary, thereby preserving the option of fundoplication in the future. The majority of the removals have occurred within 2 years after implant and have been managed non-emergently, with no complications or long-term consequences. "Expanded" indications to MSA (large hiatal hernia and Barrett's esophagus) need to be tested in further comparative studies with classic fundoplication procedures.

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