LINX Surgery for hiatus hernia?

My personal views on Linx vs Nissen are summarised below:

LINX pros:

Its 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). It doesn't repair a hiatus hernia.

If needed, MRI scans can only be at low power. MRI can displace magnets or create induction heating.

63% of recipients experience swallowing difficulties. A solid enough bolus propelled with sufficient peristalsis is required to open the device.

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, its movement against the adventia caused gradual erosion. Migration and erosion issues occurred 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 over 20 years.

The operation is minimal with patients usually 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%.)

NHS is far more likely to provide Nissen. LINX is too expensive.

Linx may look shiny and sexy but you don't see it once implanted - and it was originally developed for faecal incontinence - the Fenix device.

You may read about it and other reflux reduction devices and techniques n the Reflux management chapters of the www DownwithAcid org uk book.

I do know someone who has recently had linx implacement and am following his progress with interest. (Ealy days for him yet.) I, myself, had Laparoscopic nissen fundoplicatio a few years ago.