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,
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.