The LINX Device was first approved by the FDA for use in 2007 based upon published series of safety and outcome data. Dr. Chiasson began offering this procedure in 2015 after additional long-term published data reinforced the earlier results. Since then, he has embraced the use of this device for those individuals seeking a solution to their issues with GERD/LPRD and has developed an extensive experience with this procedure over the years.
What is the LINX Device?
The LINX Device is a small implant comprised of a variable series of interlinked titanium beads with magnetic cores that is placed using laparoscopic surgical techniques around the lower esophagus. The LINX device is intended to use magnetic augmentation to strengthen the lower esophageal sphincter (LES).
Who is a candidate for a LINX Procedure?
The LINX Procedure has been approved by the FDA for the treatment of GERD in individuals up to a BMI of 35. It can be performed as a stand-alone laparoscopic procedure in patients with GERD/LPRD who do not have a hiatal hernia. This represents a small population of patients. More commonly, the LINX device is utilized in patients who require a combined laparoscopic hiatal hernia repair and anti-reflux procedure to address their GERD/LPRD issues. Patients considering anti-reflux surgery are required to undergo a full Esophageal Function Evaluation to determine if they are candidates.
How does the LINX Device work?
The LINX device works have a two-way reinforcement of the lower esophageal sphincter (LES). The titanium beads are magnetized to maintain a pressure of 25 mm which is similar to the average pressure of the LES. When an individual swallows, the esophagus generates a pressure wave that overcomes the LINX device forcing it to expand and allow the food bolus to pass into the stomach. Alternatively, when an individual needs to belch or vomit, the pressure generated by the stomach squeezing can overcome the LINX device and force it to expand from below. The LINX device both mimics and augments the normal function of the LES.
What should you expect after a LINX Procedure?
The Laparoscopic Hiatal Hernia / LINX operation is generally an outpatient procedure. It is performed under general anesthesia. I use the latest pain and nausea control techniques and most patients experience minimal symptoms afterward. Patients are instructed regarding “physical therapy” to exercise the LINX device in order to avoid scarring and difficulty swallowing. Most individuals are able to eat normally within a few weeks of the surgery. In general, everyone learns how to eat slowly and chew their food well!
Is the LINX used for other reasons?
The LINX device may have a role to play in the management of patients with Barretts Esophagus. There is preliminary data that suggests that patients with ultra-short and short-segment Barrett’s esophagus may have up to 90% regression of their Barretts disease. In addition, the LINX device appears to have a significant role in the management of patients who, following weight loss surgery, develop severe heartburn/GERD and its complications.
What advantages of the LINX Procedure?
The LINX device provides an ideal solution to the problem of severe GERD/LPRD. It helps to restore the normal function of the sphincter that separates the esophagus and the stomach. It acts to eliminate or significantly reduce the reflux of gastric juices into the esophagus which is comparable to the traditional Nissen Fundoplication procedure. However, because of its two-way valve re-enforcement function, it significantly reduces the side gas-bloat side effects associated with the traditional Nissen Fundoplication.
What are the contra-indications to the LINX Procedure?
The LINX device is contra-indicated in patients who have a Titanium or Nickel allergy. In addition, patients who are required to undergo a 3.0 Tesla MRI evaluation should be counseled that the MRI will de-magnetize the titanium beads. Finally, the impact of having poor esophageal function (Inefficient Esophageal Motility) is not entirely clear at this time. This is an area of active evaluation in order to best counsel patients interested in this surgery.