Laparoscopic insertion of an inactive implant for gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease (GORD) is when acid and other contents from the stomach flow back (reflux) into the oesophagus (food pipe). This can cause symptoms such as heartburn, chest pain, hoarseness, difficulty swallowing, cough, wheezing and dental erosions, and can impair quality of life. GORD can occur when the lower oesophageal sphincter (LOS, the ring of muscle at the bottom of the oesophagus) does not work properly, or if the LOS moves above the diaphragm into the thoracic cavity. In some cases, part of the top of the stomach (the fundus) can also push up through the diaphragm. This is called a hiatus hernia.

The standard treatments for symptomatic GORD are lifestyle modification and drug therapy. If these do not work or are not appropriate, people could be offered surgery. One option is laparoscopic insertion of a magnetic ring at the gastro-oesophageal junction (NICE interventional procedures guidance 749). Another surgical option is laparoscopic fundoplication, a procedure that involves wrapping the top part of the stomach around the lower oesophagus (see the the NICE guideline on the investigation and management of gastro-oesophageal reflux disease and dyspepsia). For more complex cases, such as GORD with ineffective oesophageal motility, there are limited treatment options.

The procedure involves placing an implant on the outside of the upper part of the stomach wall. The implant is made from medical-grade silicone and is considered inactive because it does not move or release any chemical or biological substances. The aim is to keep the LOS in the abdominal cavity and maintain the angle between the stomach entrance and the LOS, to restore normal anatomy.

During the procedure, a section of the upper part of the stomach wall is attached to the LOS. Then, at the top of the stomach (fundus) and parallel to the oesophagus, the device is sewn into a pocket of the fundus wall (on the outside of the stomach) and sutured in place. This should be above the LOS.

This is a laparoscopic procedure done under general anaesthesia and includes repair of a hiatus hernia if present.