It consists of a simple set of titanium beads, each with a magnetic core that are linked together in a flexible chain which is then formed into a necklace around the lower oesophagus. This simply strengthens the sphincter, keeping the valve closed to prevent reflux, but allowing it to open briefly during, and then close again after swallowing.
The procedure is usually carried out by laparoscopic (keyhole) surgery. Five small incisions are made in the abdomen (two about 1cm, three about 0.5cm).
The oesophagus just above the stomach where the natural lower sphincter resides is identified. Very minimal dissection is necessary, as it is important to preserve as much of the normal structures as possible, including nerves and ligaments, as well as the natural shape of the stomach.
A measuring instrument is deployed, and the best sized device is selected. This is then carefully placed around the oesophagus and then the LINX device is locked to form the necklace. If a hiatus hernia is present, then this is also repaired with stitches. The procedure takes between 30 – 60 minutes
The LINX® system helps the LES resist opening to gastric pressures
The LINX® System expands to allow for normal swallowing.
Magnetic attraction closes the LES immediately after swallowing.
I have no acid reflux problems and it has made such a difference for my lifestyle. Thank you very, very much for all that you have done for me.
This is usually very quick, with most patients going home on the same day as surgery. There is a little bit of discomfort from the wounds while they heal, but this is usually managed with normal painkillers which are supplied. Anti-sickness tablets are also provided and advised to be taken for a few days as nausea can sometimes be a problem. Normal light activities are permitted, but heavier or more strenuous actions should be avoided. Return to work is usually after a few days or weeks, depending on occupation.
Patients are advised to eat and drink normally, but to chew their food well and drink plenty of fluids. Dry and hard foods are to be avoided. It is also encouraged to have some soft snacks between main meals to help exercise the oesophagus and keeps the device functioning.
Relief of reflux symptoms is immediate. Anti-acid medication can be stopped as soon as desired.
Dysphagia and oesophageal spasm are the most common problems after surgery. This may occur because of two reasons. Firstly, the oesophagus which has not been used to pushing against a barrier struggles with this task (like any muscle). Secondly, the body forms a fibrous capsule as a natural reaction around the device which can tighten it and make it less flexible. This is why these problems are worst at around 4-6 weeks after surgery.
Usually these symptoms resolve spontaneously and patients are encouraged to keep on eating and drinking normally and have frequents small snack-meals. This exercises the oesophagus in a similar way to physiotherapy on a muscle, and loosens the capsule making it softer and more flexible.
Occasionally endoscopy and gentle dilatation of the device with a balloon may be necessary. This weakens the natural healing capsule that forms around the device, and sometimes a short course of steroids are prescribed to prevent this happening again.
As with other anti-reflux procedures, some patients complain of bloating and flatulence after surgery. The LINX device is a two-way valve so can allow to vomiting and belching.
LINX device does not usually trigger any security alarms, but an implant card is provided to show authorities if necessary. MRI (magnetic resonance imaging) scans may de-magnetise the device, so should be avoided, or if undertaken should be limited to 1.5 Tesla power to which level the device is usually resistant to.
Erosion into the oesophagus has been reported. Some patients have also had to have the device removed because of sickness. Both these problems seemed to occur when the procedure was first introduced, and because of modifications to the technique these problems are very rare
As with any surgical operation, there are also uncommon risks of bleeding, infection and damage to internal organs, and the risks of a general anaesthetic.
Although this procedure is relatively new, outcomes have now been reported from studies which have carefully tracked patients for over five years. These show excellent levels of patient satisfaction with relief of symptoms, freedom from drug-therapy and remarkable restoration of health-related quality of life.
In Exeter, we were one of the first Centres to offer this procedure, and now have the largest consecutive series in the UK. We have been very encouraged by our own experience with excellent results and are very pleased to offer the LINX procedure as a definite treatment for reflux in appropriately selected patients.
LINX offers a new way of dealing with reflux, using a mechanical device to augment the lower oesophageal sphincter rather than reconfiguring the normal anatomy upper stomach. It therefore represents a much less invasive procedure, a concept which many patients find attractive.
Side effects such as bloating, flatulence and dysphagia are reported to be less, and patients retain the ability to belch and vomit.
Recovery is much faster, and there is no restriction on diet.
It is a relatively new procedure, so very long term outcomes (greater than 10-years) are not known, but results published so far, and our own experience are very encouraging. The procedure is becoming increasing popular throughout Europe and in the United States.