Novel technology for lower esophageal sphincter augmentation: indications and limits in current surgical practice

Abstract:

Gastroesophageal reflux disease (GERD) is primarily driven by dysfunction of the lower esophageal sphincter (LES), allowing gastric contents to reflux into the esophagus and leading to symptoms, mucosal injury, and impaired quality of life. Traditional antireflux procedures such as Nissen, Toupet, and Dor fundoplication aim to reinforce the LES and restore the physiological and mechanical components of the antireflux barrier.Yet concerns regarding postoperative dysphagia, gas-bloat, durability, and long-term recurrence have limited their broader adoption. As advances in minimally invasive surgery have progressed, prosthetic LES augmentation devices-including the magnetic LINX^TM system and the RefluxStop^TM silicone implant-have emerged as reversible, anatomy-preserving alternatives designed to directly enhance sphincter competence while minimizing common complications. This review summarizes the functional anatomy of the esophagogastric junction, core principles of antireflux surgery, and the mechanisms underlying fundoplication failure. Evidence from short- and long-term studies demonstrates that both Magnetic Sphincter Augmentation (MSA) and the RefluxStop procedure effectively reduce acid exposure, improve GERD-related quality of life, and provide durable reflux control, even in patients with impaired esophageal motility or prior failed surgery. These techniques complement traditional fundoplication and offer expanding therapeutic opportunities for personalized GERD management. Continued refinement of patient selection, procedural technique, and long-term evaluation will help define the optimal role of LES augmentation within contemporary antireflux surgery.