Magnetic Sphincter Augmentation for Hiatal Hernia with Gastroesophageal Reflux Disease

Sliding hiatal hernias involve displacement of the gastroesophageal junction (GEJ), significantly influencing the development, severity, and treatment outcomes of gastroesophageal reflux disease (GERD). Clinicians should consider an underlying hiatal hernia in patients with chronic or treatment-resistant reflux. Evaluation should assess for gastric herniation and esophageal function with esophagogastroduodenoscopy (EGD), pH monitoring, upper gastrointestinal (UGI) series, and manometry. Anti-reflux surgery (ARS) following hernia repair aims to restore normal anatomy and correct the mechanical disruption contributing to reflux symptoms. This case report focuses on a 33-year-old female with a history of a sliding hiatal hernia and GERD who presented with persistent reflux refractory to medical therapy. After preoperative evaluation, she underwent laparoscopic cruroplasty with placement of a magnetic sphincter augmentation (MRA) device (LINX(R)) around the lower esophageal sphincter (LES). The LINX(R) device recreates a reflux barrier through a ring of magnetic beads that open during peristalsis and maintain closure at rest. Its dynamic function, reversibility, and low complication rate highlight the LINX(R) device as an effective surgical option in the management of long-standing reflux associated with a hiatal hernia.