Jennifer from Austin sent us this question:” I have a slipped LINX after hiatal hernia repair and LINX surgery.
I would like to ask if you can describe the surgery that I need to have to fix this problem and what kind of surgeon can take care of it. Please and thank you so much.”
Dear Jennifer,
Slipped LINX device is another term for recurrent hiatal hernia following hiatal hernia repair and LINX device placement. There are two types of slippages depending on the location of LINX device relative to breathing muscle or diaphragm. Type one slipped LINX occurs when proximal stomach herniates through LINX device and through hiatal opening back into chest. LINX device remains located below the breathing muscle. Type 2 slipped LINX (more common), occurs when both stomach and LINX device herniates through hiatal opening into chest. The primary cause for hiatal hernia recurrence and LINX slippage is poor esophageal mobilization. During hiatal hernia repair, lower esophagus and herniated stomach are completely freed from all surrounding scar tissue caused by hiatal hernia. This step is crucial to drop the lower esophagus and stomach back into original position below the breathing muscle. Once this step is completed, hiatal hernia repair is completed by closing the hiatal opening with sutures. A bioabsorbable mesh is sometimes used to reinforce the repair.
Additional risk factors for slipped LINX device include large hiatal hernia size, shortened esophagus, and advanced patient age. Furthermore, severe coughing and/or dry heaving immediately after surgery may cause LINX slippage and recurrent hiatal hernia. Patients typically develop dysphagia (difficulty swallowing), chest pain and recurrent acid reflux symptoms like heartburn and food regurgitation. I recommend evaluation by a competent acid reflux specialist followed by surgical exploration, reduction of hiatus hernia and LINX device, proper esophagus mobilization, and closure of hiatal opening with mesh reinforcement.