LINX surgery - should I go for it?

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Would greatly appreciate more feedback from anyone who has had LINX reflux surgery.

Couple of months ago I developed the classic Gerd symptoms. Very recent pH monitoring confirms quite a lot if acid reflux. My hiatus hernia is tiny and looks like LINX would be viable.

Symptoms are maybe 30% of what they were at their worst. Annoying and means I can't enjoy big meals anymore. Dependant on omeprazole and gaviscon. Mild nausea much if the time. But u am coping. So far oesophagus is not showing any significant signs of deterioration and definitely no Barrett's.

If I go for LINX what can I expect? Will I be pleased I did it or are my symptoms well enough controlled I'd be better off without surgery?

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19 Replies

  • Posted

    Hi Pizzaman,

    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.

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    • Posted

      Thanks for the infirmative reply. You mentioned that for LNF "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". Do I take it then that once scar tissue has healed you can burp and vomit again? That would be good.

      I wonder if disphalgia with LINX is temporary or permanent.

      My symptoms are manageable but I would like to be off PPIs and avoid decades ahead of me with acid getting where it shouldn't

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    • Posted

      Scar tissue is less elastic than normal tissue and heals within a couple of weeks. (Think of it like a scab over a surface wound.) And many of us (like me) actually had no burping issues. I actually burped before I left the hospital.

      The dysphagia with links can be overcome by ensuring the food bolus swallowed is large enough and heavy enough to push the magnets apart.

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  • Posted

    Hi, I was thinking about the same procedure.

    Then i came across the "Endostim"

    Anyone who can give me some more information about that?

    I'm leaning towards the "Linx", but not so happy with the corrosion side of it.

     

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    • Posted

      Endostim, "the pacemaker for the LOS", is an exciting new product.

      The gastrointestinal surgeons I know who are against LINX are supportive of Endostim.

      We have two surgeons at Southampton who are accredited to perform the impantation, including the one who performed the first in this country.

      A big advantage is it can increase pressure on the oesophago-gastric junction to restrict reflux but does not cause any problems with relaxation of the sphincter avoiding potential dysphagia problems.

      There is a page devoted to it, including links to the latest research studies of the device in the DownWithAcid org uk book. You can find it listed in the Contents (home page) beneath Reflux Reduction Techniques.

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    • Posted

      Thanks a lot! I've found 1 center in Italy where they will perform it.

      My guess is, that it would cost dearly. I'm just not being able to take the PPI's anymore as it's eating my body.

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    • Posted

      Can you say who these surgeons are who do Endostim in the UK? Also why it might be preferable? I would need to go private as my NHS GP does not believe in operations to fix HH.
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    • Posted

      Tim Underwood has been a surgeon at Southampton for about 7 years. He is now Associate Professor of surgery. You'll find links to his profile on the listing you've posted below.

      Chris Sutton was the surgeon who performed the first Endostim implantation. He has recently joined the team at Southampton having been at Leicester previously.

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    • Posted

      Thanks for the info. I spoke to Mr Sutton 's secretary on Leicester today. Very helpful lady.

      I learnt that he also does the Stretta procedure which also sounds quite promising. Again, any thoughts on this are also most welcome. It seems even less invasive and with reasonable outcomes.

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    • Posted

      I'm not convinced by Stretta. I did have quite a few email exchanges with Sheila Doyle, Director of Marketing Communications at Mederi Therapeutics who market Stretta, when I was writing that page of the DownWithAcid org uk book.

      Research showed just 41% able to come off medication altogether.

      I was told they don't market it as a replacement for other reflux reduction techniques. I was issued withthis statement I could use: "We do not position Stretta as competitive treatment with surgery – but instead a less invasive bridge that allows some patients for whom medications are not completely effective to avoid surgery and its potential complications, or if someone has had surgery allows them an option other than additional surgery."

       I haven't managed to find anyone who has had Stretta who has said it was a lifechanger for them.

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    • Posted

      Endostim also seems to be only moderately effective from the data I read on their website. My impression is that Endostim and Stretta look interesting to consider alongside the other options. I will ask my surgeon on Monday what he thinks of the many possibilities for my circumstances. Like everyone I want a good outcome and their are enough "cons" for each option to make the decision difficult !
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    • Posted

      Saw surgeon today. DeMeester score in the 40s so clear evidence why I got symptoms. Small hiatus hernia and no oesppgahitis yet on gastroscopy. Apparently nausea as the main symptom is atypical. Bad phase has only been going for a couple of months though so surgeon recommended wait and see and keep symptom diary for a couple of months. Study the treatment options and if I then feel I want it fixed he will refer me to whoever is good at whatever procedure I go for.

      He was very open and fair. He said my symptoms are relatively mild and so I may not be as "grateful" for the surgery as some. He was aware of the post surgery symptoms associated with the different procedures and said I should set these against the current symptoms (especially as he was no sure the nausea would go on surgery).

      Quite a puzzle.

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  • Posted

    I happened upon this "thread", and wondered how you are doing? I was interested as you seemed to be considering a number of possibilities for your reflux problem, including LINX and endostim.

    Was the surgeon you refer to in your last post Chris Sutton at Leicester, or was this discussion with your NHS doctors?

    Like you, one of my pervasive and worst symptoms has been nausea, as well as classic heartburn; central chest pain, and throat symtoms.

    I wonder what you have decided to do, and whether you are sticking with the "wait and see" approach, or have decided to try one of the newer approaches, such as LINX'  or endostim?

    Hope to hear from you. Kind regards, Nigel

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    • Posted

      I had LINX with Chris Sutton.  For updates please see the FB group "LINX Complications". It's the place we ask other LINX users how to get the best out of the device and sometimes our concerns as well.

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    • Posted

      Good Luck. Hope things are going well for you.

      Any swallowing issues etc? (Perhaps I should join the FB group but I belong to too many.)

      Did Chris Sutton see you at Leicester or Southampton where he now operates?

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    • Posted

      I have asked Chris Sutton about this on one of my regular visits for follow up in Leicester and he says he does not operate or have any involvement with the team at Southampton.

      He is Head of G.I. surgery at Leicester Royal Infirmary NHS Trust, and runs his private practice, specialising in upper GI; anti-reflux, and bariatric surgery at two private hospitals in Leicester, but principally from the Spire Hospital in Leicester.

       

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    • Posted

      Thanks. It's odd. I wonder why Tim Underwood told me he had joined him in Southampton? No wonder the other gastros & surgeons haven't mentioned him.

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    • Posted

      'Tis a bit odd!! Maybe Tim just meant that he and Chris are the only two surgeons trained to offer endostim surgery in the UK?

      See you are a "night owl" like me!!!

      Best wishes.

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