A new retrospective study of 553 acid reflux patients undergoing LINX™ surgery at a single institution was recently published in the journal of the American College of Surgeons. The lead author of the study is a paid consultant to Johnson & Johnson, the company that currently sells LINX™ device.
At a mean follow up of around 10 months after surgery, 76% of patients had normalization of esophageal acid exposure (approximately 50% of patients were re-tested after surgery) and 84% reported at least 50% improvement in GERD related symptoms. 18% of patients required one dilation and 13% required more than one dilation for bothersome dysphagia. 7% required device removal. The authors conclude that LINX™ surgery is associated with “excellent clinical and objective outcomes”. They further add that LINX™ surgery “rapid, reproducible and less invasive tool to effectively treat GERD and improve patient quality of life”.
At Houston Heartburn and Reflux Center, our Nissen fundoplication outcomes are a far superior to those reported in this study. Our post-Nissen fundoplication dysphagia rate is zero. Our patient satisfaction rate is very high. All of our heartburn patients stop antacid medications after surgery. Our complication rate is zero. LINX™ device is no match to a properly performed Nissen fundoplication. Indeed, the only indication for LINX™ surgery in my book, is a surgeon’s inability to properly perform Nissen fundoplication and hiatal hernia surgery.
LINX™ mechanism of action does not address the complexity of GERD pathophysiology. The naïve concept of lower esophageal sphincter augmentation is only a small fraction of the solution. Properly performed Nissen fundoplication recreates an effective anti-reflux barrier without hampering esophageal motility. Nissen fundoplication creates no barrier against swallowing, food bolus passage and lower esophageal sphincter relaxation. Hence, a properly performed Nissen fundoplication is associated with zero dysphagia rate. Indeed, the hallmark of a flawlessly executed Nissen fundoplication is the absence of post-operative dysphagia.