LINX Revision Surgery: Nissen or Toupet Fundoplication

LINX Revision Surgery: Nissen or Toupet Fundoplication

Linda from Houston, Texas sent us this question: “A LINX device was placed 6 Months ago. Pain, bloat, and dysphasia are still present. There is occasional food regurgitation.

Some have recommended Nissen fundoplication while others recommended Partial fundoplication and the Toupet procedure

What is your experience and recommendations”.

Dear Linda,

The incidence of LINX device failure and need for revision surgery are on the rise. LINX device is a bracelet of magnetic beads that is placed around distal esophagus hoping to reinforce the anti-reflux barrier. The concept is simple but naïve. LINX device does not address the complex pathophysiology of acid reflux disease. As a result, LINX surgery success rate is much lower than the gold standard Nissen fundoplication. Furthermore, the device is not safe. It results not only in potential erosion but also in damage to esophageal motility, dysphagia and pain.

Patients who present to Houston Heartburn and Reflux Center, requesting LINX device removal and revision surgery are thoroughly evaluated. Upper endoscopy, manometry and contrast studies are routinely ordered prior to surgery. Gastric emptying study is added if symptoms of gastroparesis are present. Most patients with failed LINX surgery undergo LINX device removal, redo hiatal hernia repair and Nissen fundoplication. We prefer Nissen over Toupet fundoplication for two reasons. First, and most important, we know how to properly perform a short and floppy Nissen fundoplication that reliably stops acid reflux without resulting in dysphagia, bloating and discomfort. Second, Nissen fundoplication is more durable than a Toupet fundoplication because we suture stomach to stomach as opposed to stomach to esophagus. Stomach wall is thick and holds sutures better than esophagus.

Patients with very weak esophageal motility or with small gastric fundus are better served with a partial posterior fundoplication also called Toupet fundoplication. Less than 5% of all fundoplications performed at Houston heartburn and Reflux Center are partial fundoplications.