LINX for Heartburn: A Dysphagia Problem

Rick sent us this question: Good Afternoon Dr. Darido … I am about 9 weeks out from placement of the Linx device and repair of a hiatal hernia.
I currently am experiencing dysphagia as well as regurgitation of the contents of the esophagus.
I have discussed my problems with the surgeon who placed the device.  After a number of conversations with the surgeon I decided to take my complications to my Primary Care Provider, an Internist.
I appreciate you help.  At this point I am hoping to have the device removed and be relieved of my problems.

Thank you for your time …

Dear Rick,

I am sorry that you are going through these problems after LINX surgery for acid reflux disease. I am also surprised you are not able to get answers from your surgeon regarding your current situation. Your surgeon, not the internist or primary care physician, is qualified to deal with surgery outcome and offer solutions for potential surgery complications. You may be frustrated with LINX surgery outcome because you may have had different expectations regarding LINX surgery. LINX surgery is being promoted as a less invasive and superior treatment option for acid reflux when compared to Nissen fundoplication. In my opinion, LINX surgery is neither safer, nor less invasive than a properly performed Nissen fundoplication. Furthermore, LINX surgery is far less effective than a properly performed Nissen fundoplication in terms of controlling acid reflux related symptoms. For these reasons, I hesitate to offer LINX surgery to my acid reflux patients.

In general, dysphagia is very common after LINX device placement and patients are encouraged to consume regular diet to stretch the distal esophagus and prevent scar tissue formation. Sometimes, your surgeon may need to perform balloon dilation to improve swallowing. In certain cases, LINX device has to be removed or replaced with a larger size. In addition, LINX device placement is contraindicated for patients with weak esophageal motility. Did you have esophageal manometry testing prior to LINX surgery to evaluate esophageal contractions?

Current studies utilizing Endoflip technique to measure compliance of distal esophagus at the time of LINX placement are underway in Houston to help decrease post LINX dysphagia rate. So far, there are no published guidelines regarding intra-operative Endoflip use.