What Happens after LINX Surgery?

What Happens after LINX Surgery?

Harry from Houston sent us this question: “After over a year following LINX surgery I’m still having problems with food getting stuck.

It seems to happen mostly when I sit down to eat lunch or dinner and with certain foods.
It can be painful but I’m wondering if I’m eating too fast. I have no heartburn, so it seems to be working but at times my food gets stuck. What can I do? “

Dear Harry,

Dysphagia or difficulty swallowing is a common problem after LINX device placement for treatment of heartburn and acid reflux. LINX device, a bracelet of magnetic beads, creates a barrier against esophageal emptying of food into stomach. Flow across LINX device depends on food bolus pressure and esophageal wall compliance. The higher the pressure and the lower the compliance the greater is the flow. Food bolus pressure is generated by esophageal contractions. If you have ineffective peristalsis, LINX device placement is contraindicated. Esophageal peristalsis is measured prior to anti-reflux surgery using manometry. Esophageal wall compliance is not typically measured prior to surgery. Most patients with acid reflux have decreased wall compliance favoring backflow of acid into esophagus. LINX device placement causes increased scar tissue formation around distal esophagus. Scarring causes not only physical narrowing of esophageal lumen but also decreased esophageal wall compliance. Decreased esophageal wall compliance is a two-edge sword. It decreases acid reflux and heartburn, but it hinders swallowing. Esophageal lumen narrowing responds to balloon dilation. Esophageal wall compliance, on the other hand, is not possible to alter without removing the LINX device.

Patients with decreased esophageal wall compliance secondary to LINX device placement typically present with odynophagia (painful swallowing) and solid food dysphagia (difficulty swallowing). Chewing food well before swallowing helps decrease symptoms. Ultimately, treatment involves LINX device removal and conversion to Nissen fundoplication.

Properly performed Nissen fundoplication is currently the most reliable treatment for acid reflux. Properly performed Nissen fundoplication is safer and more effective than LINX surgery. Dysphagia post Nissen fundoplication surgery at Houston Heartburn and Reflux Center is very rare. A short and floppy Nissen fundoplication, unlike LINX device, creates very little resistance against esophageal food emptying into the stomach.