Surgeons perform LINX surgery to prevent the reflux of gastric contents into the oesophagus. Clinical trials have proven its high efficacy in the treatment of GERD. In addition, the procedure is minimally traumatic, does not disturb the anatomy of the gastrointestinal tract, and does not cause serious complications or adverse reactions.
The specialists in gastroesophageal reflux disease (GERD) and gastrointestinal surgery made a significant breakthrough in minimally invasive treatment. The LINX reflux management system is a modern and straightforward laparoscopic operation to strengthen the lower sphincter - (special muscle) between the oesophagus and stomach. After all, the dysfunction of this particular muscle is the leading cause of GERD. As a result, it will restore the natural barrier to reflux without any anatomical changes and with minimal side effects.
The LINX is a small, flexible chain of titanium balls with a magnetic core. The magnetic attraction between these beads keeps the sphincter closed, preventing reflux. LINX is designed to temporarily open when swallowed, allowing food or liquid to pass into the stomach. The magnetic balls are then attracted back and keep the sphincter closed. As a result, it prevents the stomach's contents from returning to the oesophagus.
This procedure is available only in specialised and certified centres. The system was developed by the American company Torax Medical. It was FDA approved for the surgical treatment of GERD in March 2012, and in June 2015, the agency approved the next-generation device.
LINX surgery step-by-step
Before the procedure, patients should undergo a preoperative examination, which allows the surgeon to qualify the patient. Such diagnostic procedures include:
- X-ray of the stomach with barium contrast;
- Endoscopy of the upper gastrointestinal tract (oesophagus and stomach);
- Oesophageal manometry (study of oesophagal motility);
- The 48-hour acid test to determine the frequency of reflux;
- Laboratory tests.
If there are no contraindications, the patient is assigned a date for the procedure. The installation is performed laparoscopically (without wide incisions) under general anaesthesia and lasts no more than one hour. The abdominal surgeon makes tiny incisions and inserts a laparoscope with microsurgical instruments and a chain of titanium beads into the abdomen.
The device is placed around the oesophagus directly above the stomach. A special tool is used to measure the outer circumference of the oesophagus, which makes it possible to select an antireflux system of a suitable size.
After placement, the incisions are closed with sutures. Then, the patient stays in the hospital for several hours. Sometimes a doctor can extend the period of hospitalisation by one day.
When can the LINX surgery be the option?
LINX is a modern treatment for gastroesophageal reflux disease with abnormal pH values. It is indicated for patients with chronic symptoms, despite long-term therapy. The use of a device should be considered based on medical history and severity of symptoms.
It is also worth noting some points and conditions before LINX surgery:
- The patient must be over 21 years old;
- The patient must not be allergic to the components used: titanium, iron and nickel;
- The patient does not have pacemakers or other metal implants.
Gastroenterologists and surgeons consider the patient's medical history (duration, previous treatment and existing symptoms) and prescribe the procedure if there is a chance of achieving high efficiency.
Advantages of LINX surgery for GERD
The system is a worthy alternative to the classic antireflux operation, which was developed over fifty years ago. It does not require intervention in the anatomical structure of the stomach. In addition, the procedure is minimally invasive, using laparoscopic equipment inserted through a small incision in the abdomen.
The success rate is very high. Approximately 92-95% of patients stop taking the medications needed to relieve reflux symptoms. The remaining 5-10% of patients rarely resort to drug therapy.
Short recovery time after surgery is also a significant advantage. Patients usually return home on the same day. They are recommended to eat solid food immediately after the procedure. The absence of a prolonged postoperative period and complications (as with open surgery) significantly simplifies and improves the quality of life. Complications occur extremely rarely (less than 3% of cases) and are eliminated by removing the antireflux system.
Patients prefer LINX surgery also because it does not disturb the physiological structure of the oesophagus, stomach or sphincter between them. A titanium implant only improves the functioning of the organ. And in case of removal, it does not cause irreversible changes.
What are the risks?
The surgery and the device are simultaneously safe and effective, but certain risks remain. Specialists still recommend removing the titanium device in case of an urgent need for an MRI (however, LINX is considered compatible with an MRI scan). Scanning for various reasons can lead to severe damage or affect the strengthening of the magnetic properties and reliable functioning of the system. In addition, if the LINX is not secured correctly, it may shift later. And correcting these complications requires an additional operation.
The frequency of complications after the operation is low - approximately 3-5%. Side effects of laparoscopic surgery include reactions to anaesthesia (headache, muscle pain, nausea), bleeding, or infection.
LINX reflux control system complications might include achalasia (decreased relaxation in the lower part of the oesophagus), damage to the surface of the oesophagus by the device, displacement of the device, diarrhoea, dysphagia (swallowing issues), inability to belch or induce vomiting, impaired gastric motility, nausea, and stomach bloating.
The LINX device is a long-wearing implant, but a patient may need surgery to remove and replace it at any time. In addition, treatment of side effects may include removing or replacing the implant. After that, the condition is entirely normalized. Therefore, even unforeseen complications do not cause significant damage and are easily solved by surgeons.
What is the recovery after LINX surgery for GERD?
The LINX Reflux System works right after implantation. After the procedure, the person can eat under the physician's guidance. In addition, it resumes normal activities in less than a week. Unlike other types of surgical treatment of reflux disease, the introduction the LINX surgery does not require any anatomical changes in the stomach.
After surgery, eating some meals is essential to keep the system working correctly. However, in some rare cases, patients noted mild discomfort approximately two weeks after surgery when food passed through the oesophagus. It happens due to healing or scarring around the LINX implant. At this point, it is crucial to continue to eat regularly to keep the titanium beads moving. But each patient reacts differently to these situations, so the symptoms vary from mild to noticeable.
Six weeks after surgery, most patients have almost no symptoms. And 12 weeks after the operation, the healing is complete, and the patient can eat and drink everything. Moreover, no more medication is needed after the procedure.
Why is LINX considered the best for GERD?
This approach is the newest discovery in the treatment of GERD and has already shown excellent results. It helps improve patients' condition and allows them to quit drug treatment altogether. Moreover, the LINX procedure does not impair the quality of life: a person can eat, drink, swallow, or vomit as usual. And laparoscopic access does not cause complications and allows the patient to return to ordinary life on the same day.
Who is the candidate for LINX surgery?
This operation is indicated for non-obese patients with confirmed 24-hour ambulatory pH monitoring of GERD in stages A-B according to LA classification (or Savary-Miller grade I-II). The crucial point is the persistence of disease symptoms despite maximum medical therapy, with normal motility.
What is the success rate of the LINX procedure?
The success rate for LINX surgery is very high. For example, 90 to 95% of the patients who undergo this procedure can stop taking medication entirely, and the remaining 5 to 10% rarely take medication.
Why are patients travelling abroad for LINX?
LINX systems have been approved as an effective treatment for GERD relatively recently and are not yet available in some countries. Patients prefer visiting clinics in Germany, Israel, Turkey, the Czech Republic and Poland. In these countries, doctors have already gained the necessary experience and have a high success rate. And the equipment for the procedure and components are certified and meet all quality standards.
How long does LINX surgery take?
The whole procedure usually takes near an hour. Then, patients can leave the hospital and return home after an overnight stay. There they are monitored by doctors for any complications that may arise.
What are the best clinics for LINX surgery?
Who are the best doctors for LINX surgery?
Prof. Dr. med. Helmut Friess from University Hospital Rechts der Isar Munich
Prof. Dr. med. Jens Werner from University Hospital Ludwig-Maximilians Munich
Dr. med. Niels Huschitt from Academic Hospital Bundeswehr Berlin
Prof. Dr. med. Wolf O. Bechstein from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Jurgen Stein from Academic Hospital Sachsenhausen Frankfurt am Main
How much does LINX surgery cost?
The price of the surgery depends on many factors and varies widely: 6,500 $ - 32,000 $. To find a specific cost, you should contact AiroMedical and choose the desired clinic and specialist. Destination for GERD treatment plays not the last role in the final bill. Based on this, our specialists can give a more accurate cost estimation.
It should also be taken into account that the entire package usually includes:
- Preoperative diagnostic procedures;
- Specialist consultation;
- The operation itself;
- Subsequent examinations (to control the treatment effect).