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LINX vs. Fundoplication for GERD

So, one of the questions we get when we offer anti-reflux or anti-GERD or anti-heartburn surgery to patients, is what is the difference between a traditional Nissen Fundoplication and LINX surgery. So, LINX surgery is a newer operation which is basically a magnetic beaded ring that goes around your lower esophagus that keeps the gastric juices in your stomach where they belong. The device keeps the acid from coming up into your esophagus and causing heartburn and GERD and all the problems that come along with them.

Now, the fundoplication is the traditional operation to prevent this as well. What it involves is taking the fundus, or the upper part of the stomach, wrapping it around the lower esophagus and suturing in place. That gives you a muscular sphincter.

When the LINX came around, it was smaller, it didn’t require a change of anatomy with the stomach, it was fairly simple in the right hands – to put it around the esophagus – and so it’s a very attractive procedure from that standpoint.

There are some subtle differences. For the LINX, because it’s a mechanical device, what we find is dysphagia or some difficulty swallowing in the early period of recovery is a bit more pronounced than in the fundoplication. It can last up to three or six months in some cases, but most of the time it does go away and then you can enjoy your life free of antacids and heartburn. With the fundoplication the dysphasia is still there, but it’s a little bit less – you might have a little bit more gas bloating. The results for both operations are about the same.

So in making the decision of who’s a good candidate for the LINX and who’s a good candidate for the fundoplication a lot of it has to do with patient preference. As a surgeon, I also assess how well the esophagus in the patient functions. We do a test called manometry, where we place a probe into esophagus and measure pressures during swallowing. If you don’t have a well-functioning esophagus you’re not a candidate for LINX. You shouldn’t let anyone put a LINX in you if your esophagus is poorly functioning – you’ll have a very difficult time swallowing.

If you do have esophageal dismotility, then a good option for you is the partial Fundoplication, where instead of going 360 degrees around your esophagus with the fundus, we go 270 degrees either over or under your esophagus.

So, that gives you an anti reflux mechanism but it a is not tight enough that you won’t be able to swallow past it if you have a weak esophagus.

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