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.