I am really struggling with acid reflux and am considering the linx operation.

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I have throat ear and voice problems which seem to be getting worse.  My health seems to be slipping away and tablets have done little to help. Has anyone had this in the UK and if so who was their surgeon and are they glad they had it done?

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  • Posted

    Although LINX may be the best artificial augmentation device for a weak Lower Oesophageal Sphincter, and is available on NHS, you may find difficulty getting it as it costs more than twice as much as the gold standard Laparoscopic Nissen Fundoplication.

    The following is a bit long, I'm afraid but is my comparison of the two procedures:

    You will find many people who are definitely pro LINX. Personally, although I am not anti-LINX, I am a bit guarded and definitely pro Laparoscopic Nissen Fundoplication (LNF).

    Most of my gastroenterologist friends, colleagues and surgeons are anti-LINX. You need to weigh up pros and cons to decide and getting feedback from those who have had it implanted is a good first step. What we don't know yet, and they can't tell you, is how it will last over a lifetime.

    LINX pros:

    It's ring of magnetic beads help close the lower oesophageal sphincter.

    The surgery for this is slightly less invasive and slightly shorter than for LNF and there is less (internal) healing for the body to do. It has been available for nearly 15 years. The operation is minimal and patients can go home the next day with some able to go home the same day.

    You can eat normally afterwards.

    If it doesn't work or goes wrong, it can be removed and LNF performed instead.

    A "long term" study over 6 years (with a mean implantation time of 3 years) of 100 recipients showed 85% of them no longer required daily PPIs for acid reflux and were glad they had had the procedure.

    LINX cons:

    It costs over twice as much as LNF.

    It cannot be used in everybody (depends on presence of Barrett's and hiatus hernia).

    If needed, MRI scans can only be at low power.

    63% of recipients experience swallowing difficulties.

    LINX unknowns:

    Will it migrate or erode the adventia (outer wall of oesophagus) over time? 40 years ago, a new device was being enthusiastically embraced. Angelchik was effectively a broad gel rubber band / collar attached around the oesophagus that kept the oesophagus closed by elasticity. However over a long period, it's movement against the adventia caused gradual erosion. Migration and erosion issues occured causing a clamour of patients having it removed.

    LNF pros:

    It is the gold standard for reflux reduction surgery.

    Nissen fundoplications have been used for 60 years with surgeons becoming more expert and techniques improving all the time. It has been performed laparoscopically for the over 20 years.

    The operation is minimal with patients able to go home the next day (and some on the same day as their operation).

    It uses natural body tissue with similar elasticity to the organ it surrounds.

    A recent study of nearly 200 patients who had LNF 20 years ago found 94% satisfaction with it.

    There is no risk of erosion or migration.

    Any hiatus hernia will be corrected and the Nissen wrap prevents it from recurring.

    It can be performed if the patient has Barrett's.

    LNF cons:

    85% of patients experience problems with burping or vomitting whilst the scar tissue heals.

    50% of patients have swallowing difficulties while the scar tissue heals. Soft foods are required at first but you can eat normally within a few weeks.

    In the 20 year study, the wrap had failed in 18% of patients, when it can be redone. (Newer techniques mean that failure rates are now estimated to be only around 5%.)

    LINX vs LNF mistruths;

    LINX has been heavily promoted in USA. Every time a new clinic offers the treatment it gets press coverage and being "New" and with the device looking "sexy" it is a popular choice until patients find their insurance may not pay for it. In UK, it has received NICE approval but the cost (together with the reservations expressed above) means it's not easily available on NHS.

    Torax medical who make LINX sell it on its being removable if it goes wrong and you can still get LNF. (That's like selling you a Ferrarri that may not run and being told if it goes wrong, you can still buy a Ford.)

    They say LNF cannot be undone. If necessary, it can but who'd want to?

    They also make a big deal about the burping and vomitting issues but cover up their dysphagia issues.

    At the end of the day, it's up to you to decide. Most people who have had LINX or LNF done are glad they did.

    Another recent treatment that does look promising is Endostim but it's early days yet and you'd probably have to pay for that.

    See DownWithAcid org uk and find the chapter on Reflux Reduction Techniques where these and other treatments are reviewed.

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  • Posted

    Thank you Barretts, I appreciate your input and will be giving it some thought.
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  • Posted

    There is plenty of evidence that people who have had a Linx operation are very happy with the results. Presumably you have not responded to treatment with either the PPI group of drugs or the H2 Receptor Blocker group.

    A very large percentage of the population have a Hiatus Hernia without knowing but it may well have resulted in your problems together with a poorly performing sphincter at the bottom of the Eosophagus.

    I take it that you have had an Endoscopy ?

    Eosophagitis can be very damaging in the long run and once you start having swallowing and voice problems afffected by Reflux maybe the time to think again.

    There are two operations for your problem. One requires specialist surgical skills of the highest standards - is difficult - and not without possible side effects. The operation should be avoided wherever possible.

    Linx on the other hand is a simple procedure requiring a small incision under general anaesthetic.

    The small band of magnetic beads no bigger than a fifty pence piece and measured to the size of your Oesophagus is placed around the gullet.

    And if you don't get on with it , it is just as easily removed.

    You do not need to search the land for a surgeon with this one. But it is wise to ask if the surgeon has previously inserted a number successfully

    Best wishes

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  • Posted

    Thank you derek58875.

    ​Just to give some background I am 53 and have had an endoscopy and have a 3cm sliding haitus hernia.  Have been on Lansoprazole, 30mg for first month and then 60mg.  I felt that my reflux was worse on this as I was getting white froth coming up which I never got before. I had bad rebound coming off it.  Now on ranitidine and gaviscon.  I also use DGL, alkaline water, and slippery elm.  

    ​I have made changes to my diet- no caffine, alcohol, citrus,chocolate etc.

    I would like to hear from people who have had successful surgery in uk and to find out where they had it done so I can weigh up pros and cons if I have to go down this route. To my mind the surgeon is crucial.

    ​I am quite miserable and concerned about my throat.

    Thanks for your support.

     

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    • Posted

      Difficut I know but do try not to get down. Think of it as an unpleasnt problem that you will beat in the end

      I take it that the Endoscopy showed no signs of H. Pylori ?

      In which case it boils down to the hiatus hernia. And you are much better to have a Sliding hiatus than a Rolling  one where the stomach protrudes much nearer the Eosophagus.

      Good job to be off the PPI and onto Ranitidine - not quite as effective but with much les serious long term side effects.

      Think of it as Linx is going to cure you. I remember seeing a list of surgeons who specialise in various procedures but I can't remember where at the moment. Can't the Gastrooesophageal Consultant who agreed to you Endoscopy help ?

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  • Posted

    You are right Derek58875.  I need to be more positive.  I didn’t know there was a difference between sliding and rolling hernias so that has cheered me up.  I see the consultant the week after this, so am hopeful that tests can be put in motion.  My ear is very sore at the minute. The acid seems to go into my Eustachian tube and I have hearing loss and very loud tinnitus.  Just concerned that my ear, and throat do not get badly damaged before something can be done. I am sure the consultant will be able to give some answers which will help.

    Your support really helps.  Thank you.

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