Electrical stimulation of the lower esophageal sphincter to treat astroesophageal reflux disease: Technique of implantation

Abstract

Objective: Electrical stimulation of the lower esophageal sphincter (LES) to treat gastroesophageal reflux disease (GERD) leads to a normalization of esophageal pH and enhanced LES pressure. It effectively improves symptoms of GERD without the typical side effects of traditional antireflux-surgery. Methods: Illustrated by the cases of a 54-year-old female patient with worsening GERD despite maximized acid suppression therapy and of a 47-year-old male patient with GERD after sleeve gastrectomy, crucial points of implantation and perioperative minutiae are shown in this video. Results: The usual patient placement and trocar positioning for laparoscopic antireflux surgery is used. After identification and exposure of the anterior gastroesophageal junction, the electrodes are sewn into the esophageal wall. Extraluminal placement is secured with endoscopy. The lead electrical connector is then pulled through the abdominal wall and attached to the pulse generator. After a first functionality test, the generator is placed in a subcutaneous pocket. A final functionality test is followed by initiation of treatment. Conclusion: This standardized technique for the implantation of an electrical LES-stimulation-device using easily reproducible steps leads to a good peri- and postoperative outcome and is the foundation for the long-term efficacy of this method