LINX Removal without Nissen Fundoplication

LINX Removal without Nissen Fundoplication

Liam from Dallas, TX sent us this question: “I am 57 years-old, and in excellent shape. I had LINX surgery performed in May 2021. I am having significant problems with swallowing now.
I am scheduled to see my surgeon next week. I am scared that my swallowing problems are permanent, but his surgical assistant told me that “dysphagia” in some patients require Dilation. I just cannot understand why the LES would cause problems with “swallowing.” I hope it does, and that this is not something more serious. Please tell me that swallowing problems (in my throat area) are associated with LINX. Also, can I just get it removed without the fundoplication? I just want this thing out. I would do anything to be normal again. Thank you so much for any advice. Liam”

Dear Liam,

Late onset dysphagia (difficulty swallowing) after LINX placement requires further investigation and testing prior to endoscopic balloon dilation. Barium swallow is first performed to rule out LINX erosion, LINX migration into chest and recurrent hiatal hernia. At Houston Heartburn and Reflux Center, we perform a concomitant esophageal manometry to rule out loss of esophagus contractions and ineffective esophageal motility as a cause for dysphagia. LINX removal and subsequent or concomitant conversion to fundoplication surgery are indicated if any of the above conditions are confirmed.

LINX removal alone without fundoplication surgery puts you at risk for recurrent acid reflux disease. Hiatal hernia repair by itself following LINX removal is not enough prevent acid reflux. Nissen or Toupet fundoplication is needed to recreate the anti-acid reflux barrier and stop GERD.

A properly performed Nissen fundoplication and hiatal hernia repair is currently the most reliable treatment for acid reflux disease. The procedure is safe, and it is associated with less than 1% complication rate. At Houston Heartburn and Reflux Center, our dysphagia rate following Nissen fundoplication and hiatal hernia repair is zero.