Jeremy from Houston sent us this question: “I am a 68-year-old male pretty healthy and had the LINX procedure 6 months ago. I never had many of the problems people were complaining about on Facebook. Acid reflux at night completely gone but I do struggle getting food past the LINX device into my stomach. The Surgeon said it would gradually get better and it is. I just ate thin crust pizza no problem but a hamburger with bread, I really have to watch out for bread and have chocolate milk on hand”.
Dysphagia or difficulty swallowing is a common complication associated with LINX device. Early dysphagia after LINX placement is very common due to swelling of tissues. Most patients slowly improve and are able to tolerate regular diet. LINX patients with persistent dysphagia require endoscopic balloon dilation to breakdown scar tissue formation and try opening up esophagus lumen. If balloon dilations fail to alleviate dysphagia symptoms, LINX device removal is recommended.
I agree with your surgeon, Jeremy, dysphagia gradually gets better after LINX surgery for two reasons. Swelling goes down with time, but most importantly esophageal contractions recover and improve after stopping acid reflux. It is hard, however, to predict the degree of improvement. Some damage to esophageal motility is irreversible even after repairing the hiatal hernia and stopping acid reflux. It is helpful to repeat esophageal manometry one year after LINX surgery and check for contractile strength. If esophageal contractions remain weak one year after surgery, LINX device may need to be removed and replaced with a fundoplication.
The advantages of Nissen fundoplication over LINX surgery for acid reflux management are numerous. Nissen fundoplication is much more effective than LINX device in terms of controlling heartburn because it does not simply rely on lower esophageal sphincter augmentation. Consequently, a properly performed Nissen fundoplication is loosely constructed around the lower esophageal sphincter so as not to cause dysphagia. Indeed, our post-Nissen fundoplication dysphagia rate at Houston Heartburn and Reflux Center is less than 1%.