Linx or Nissen surgery?
Posted , 6 users are following.
Hello I have heard success stories with both of these surgeries but I'm looking in to seeing if my insurance will cover the Linx surgery. I appreciate you all putting your stories out there for people like me to read. If I can have the Linx I am going to go ahead with it. If I can't and insurance does not cover it I will go ahead with the Nissen. I have been on Nexium for almost threee years. I have Gerd, ulcers, 5 cm hernia that needs repaired. Thank you and again I appreciate any one that can help me or tell me how they are doing after either surgery. I was diagnosed with stage 4 erosion of the esophagus back in 2013. Take care all of you. Lorray
0 likes, 17 replies
Barretts lorray64454
Posted
Hi Lorray,
Firstly, with a 5cm hernia, you may not be eligible to have LINX. Unlike the Nissen wrap, the procedure does not correct nor hold a hiatus hernia against sliding.
If you go to the www DownWithAcid org uk site, you will find a comprehensive section devoted to the various reflux reduction techniques including the various fundoplications and other surgical and mechanical devices including the LINX magnetic sphincter augmentation device.
I am a strong advocate of Laparoscopic Nissen Fundoplication (considered the gold standard in reflux reduction) having been a recipient of it myself and it gave me my life back (from being anaemic (due to PPI induced hypochlorhydria) unable to walk 50 yards to cycling 30 miles a day before breakfast) and totally med free.
Nissen fundoplication has been practiced for 50 years, the last 25 of which, laparoscopically.
A study published in Surgical Endoscopy in 2014 reviewed the durability of Laparoscopic Fundoplication over 20 years and concluded, "Long-term results from the early experience with LF are excellent with 94 % of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up. However, 18 % required surgical revision surgery to maintain their results. There is a relatively high rate of daily dysphagia but 90 % of patients are happy to have had LF."
LINX looks like the best alternative to LNF but I have concerns.
From the Down With Acid book: 'A report in the Journal of American College of Surgeons highlighted on the Torax website, "One Hundred Consecutive Patients Treated with Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease: 6 Years of Clinical Experience from a Single Center" examined results of patients having had the implant an average of 3 years. It concluded "Magnetic sphincter augmentation for GERD in clinical practice provides safe and long-term reduction of esophageal acid exposure, substantial symptom improvement, and elimination of daily PPI use." and "Freedom from daily dependence on PPIs was achieved in 85% of patients."'
It is sold on an inaccurate representation of LNF as being irreversible - which is untrue. (If it was ever necessary, the wrap could be undone almost as easily as removing a LINX bracelet) They also claim you cannot burp or vomit which may be true for some patients for the first few weeks whilst internal scar tissue heals. (I burped before I left the hospital the day after my LNF surgery.) But with LINX the problem is swallowing - reported by 63% of recipients. A dense enough bolus needs to be swallowed with sufficient peristaltic pressure to open the device.
My other main concerns are migration, erosion and overgrowth. Lifetime studies are, of course, unavailable. Some years ago, Torax told me they were unsure about whether the device would migrate which is why they do not recommend it for those of us with Barrett's. Over time, will the movement of the magnets against the adventia (outer surface of the oesophagus tube) cause erosion? Will cellular overgrowth over time prevent the movement of the magnets? One further concern is if you need an MRI scan it can only be done at low power. Not only will it pull at the magents of the device but the wire bracelet will act as an induction coil (like an electric hob).
You may wish to read about Angelchik in the Down With Acid book - a device introduced in the 70's. Effectively a rubber band around the lower oesophageal sphincter, it was heralded with much acclaim as LINX is today but 20 years down the line, everyone was having it removed because of the migration and erosion problems.
Finally, as you have pointed out, LINX is more expensive and many insurance companies in US may not pay for it.
lorray64454 Barretts
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lorray64454 Barretts
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jane08689 lorray64454
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Hi Lorray, I hope you dont mind me asking but I was wondering how you were doing ? I'm in two minds about which way to jump with the surgery the Nissan is tried and tested but the Linx seems to be less invasive ?? Its such a mine field isnt it?
Barretts jane08689
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lorray64454 jane08689
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Hi Jane I am doing really good. I had the 270 wrap and a hiatal hernia repair. The surgery wasn't as bad as I thought it would be. I had shoulder pain after surgery but it didn't last too long. It was a slow time getting back to eating but not that bad. I can now eat or drink any thing I want although I do try and be careful. However drinking pop still burns so I do not drink pop. I know it can be difficult to decide which was to go. I had met someone in Seattle that had the
surgery 6 years ago from my same
surgeon Dr Brian Louie at Swedish and she was doing really good 6
years out and was still so happy she
had it done. I wish you all the best in deciding which was too go.
Please let me know if you have any more questions as I would be more then happy to help you in any way I can. Best of luck. 💕 Lorray
jane08689 lorray64454
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Thank you so much for replying it is very hard I think it's really got so much with who does the surgery so I'm recerching all the surgeons available . I'm sure if I get that right it will all go ok . Will let you know
jane08689 Barretts
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Hi I was wondering who did your surgey ? I'm going to have it doen as will not go down the drug roiute they keep trying to get me on . Thankyou
jane08689 lorray64454
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Barretts jane08689
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I had my surgery at Southampton General Hospital.
They have some excellent upper GI surgeons. (Also available privately at the Spire, Southampton.) I would personally recommend Jamie Kelly (who invented laparoscopic Ivor Lewis oesophagectomy for when it's necessary (though no one believed it was possible) and Jim Byrne who did my Collis-Nissen revision. Then there's also Tim Underwood who's also an excellent surgeon.
jennifer86221 lorray64454
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I had the Linx operation nearly 3 weeks ago. I had to go privately and it cost me about £9500. I researched my surgeon and he seemed ideal. The op appeared to go well but I soon started having severe pain. ..... long story short... A barium swallow xray showed that the Linx had moved and would not open to allow food through. There was less than a 1cm gap, allowing stuff to drbble through. No wonder I had been in severe pain for over 2 weeks! My surgeon is now off sick and I am spending this weekend unable to eat at all, only able to drink. I have been told to ring first thing Monday morning as I cannot be in this situation for long. They have offered to move the Linx into the correct position and I think I will accept. But I am very worried that things will again go wrong. I would prefer to have the thing removed but I will then lose all the money I paid and physically be back to square one.
Barretts jennifer86221
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I am sorry to hear this.
Torax medical had revealed to me some years ago when Linx first came to UK, that they were concerned about possible migration of the device. Unlike fundoplication, it is not anchored in place.
The surgeon who carried it out should fix it. That's what you paid him to do. But you need some assurance from him regarding its longevity.
Would they do a fundo to replace the linx, if you considred that an option?
Meanwhile, I guess you're on a liquid diet?
jennifer86221 Barretts
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Yes, I am on a liquid diet. Not a massive problem, don't feel very hungry and am just glad to lose the pain. Your comments re migration of the device are very apt. Another surgeon has offered to move the device and stitch it in place. I have to decide whether to accept that offer tomorrow morning. I have had an unreasonable fear of fundoplication which I could have had done on the NHS. Just looks frightening and I heard so much against it.
I am now in a dilemma but I can't turn back the clock. Things are what they are. I would really appreciate your comments If you have time to get back to me today.
Thank you so much for all your help and comments
Barretts jennifer86221
Posted
Of course, it's your call.
You may either stay with Linx and have it sutured in place, if they can do that without restricting the closure of the magnets, or have it removed and have a fundoplication.
You are not alone. A research paper published last year followed patients who underwent a Linx implant between 2007 and 2015 in Milan.
"Over the study period, 164 patients underwent a laparoscopic Linx implant and had a median follow-up of 48 months. Eleven (6.7%) of these patients were explanted at a later date. ... In 2 patients, full-thickness erosion of the esophageal wall with partial endoluminal penetration of the device occurred. The median implant duration was 20 months, with 82% of the patients being explanted between 12 and 24 months after the implant. Device removal was most commonly combined with partial fundoplication."
There has been much fear spread about fundoplication - much of it by Torax medical making false claims! but there are many studies showing it is well received. Here sre the conclusions of one: "Nissen Fundoplication has a positive impact on quality of life and is effective in reducing symptoms of heartburn, regurgitation, burping and difficulty lying down associated with a hiatus hernia. There is however an increase in the incidence of flatulence associated with the procedure. In spite of this, 94% of patients would recommend the procedure to someone else."
My own fundo was the best thing I ever did.
jennifer86221 Barretts
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Thank you. I really appreciate your input. I am still arguing with myself about the best route to take. If I walk away now I have lost every penny I paid. The device cost £3000 and although I know health is more important than money, I am tempted to allow the surgeon to move it back into position and see how it goes. If it fails again it will have to be removed and I can consider fundoplication. My hiatus hernia is not large and I obviously felt better before I had this operation. I had the head of my bed raised, I took PPIs and I ate a sensible diet. I was OK apart from the occasional flare up.
I now know more about the device and what questions to ask the surgeon. Tomorrow I will have a full and frank discussion with him and make my final decision
Thanks again
jennifer86221 Barretts
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I saw the replacement surgeon yesterday evening. He has examined the barium slip Xrays and decided that the linx hasn't moved! I don't believe him for one minute.
(The consultant radiographer and his team were convinced it had moved and showed me the Xray. My oesophagus was half full of barium, It was leaking out into a 3inch tube less than 1cm diameter then running into a long wiggly tube about 1mm diameter. I said 'nothing gets into my stomach' and they agreed. They called my husband and took us into a room to talk. The consultant said he would let my surgeon know and suggested I stick to liquids until I heard from someone.)
Having said the linx hadn’t moved he gave me a number of alternatives, his favourite being the cheapest, I start eating again to open up the linx. That is out of the question. He suggested I had not been eating solids which is not true. I persevered for 2 weeks of pain until one morning I took one spoonful of cereal and was in agony for 3 hours. The day before I had been in pain after one spoonful of porridge.
I have chosen to have it removed and I hope to be having it done on Saturday
nasir12345 jennifer86221
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hi jennifer i know its been a few years but i was wondering how you are now with your linx and how you are feeling now. thank you