LINX® Reflux Surgery at Tees Hospital

What is LINX® reflux surgery?

The LINX® System is a surgical procedure to prevent symptoms of acid reflux. It involves placing a small, flexible band of interlinked titanium beads with magnetic cores around the oesophagus just above the stomach. This helps create a barrier to the reflux of acid and bile.

The LINX® System is placed around the oesophagus just above the stomach during laparoscopic, or “keyhole,” surgery, which is generally completed in less than an hour.

When the LINX® System is in place, swallowing forces temporarily break the magnetic bond to allow food and drink to pass normally through the Lower Oesophageal Sphincter (LOS). The magnets then close the LOS immediately after swallowing to restore the body’s natural barrier to the reflux of acid and bile.

There have now been around 40,000 operations worldwide and the results are very encouraging. LINX® has been shown to work very effectively to stop reflux symptoms. As a minimally invasive procedure, it is considered safe and has fewer associated side effects than fundoplication operations (fundoplication has a 5-10% revision rate within 5 years due to technical failure or recurrent symptoms). Patients recover rapidly from the operation.

What happens during LINX® reflux surgery?

The operation will be performed under general anaesthetic and usually takes less than an hour.

Your surgeon will make a small cut on or near your belly button so that they can inflate your abdominal cavity with carbon dioxide. They will make several small cuts on your abdomen, through which they will insert a telescope and surgical instruments to operate.

Your surgeon will assess the size of your oesophagus and choose the correct LINX® device for you. The magnetic ring of beads will be placed around the bottom of the oesophagus, and the magnet is locked in place. Your surgeon will remove the instruments and close the cuts.

Recovery from a LINX™ procedure

After the operation, you will be transferred to the recovery area before heading back to the ward.

You will be given anti-sickness medication. You should start on soft foods on the day of surgery, before returning to your normal diet the day after surgery.

You may be able to go home the same day, although your surgeon may recommend you stay in the hospital for a little longer.

Continuing your recovery at home

You should be able to return to work after a few weeks.

You should avoid manual work and heavy lifting for a few weeks. Check with your healthcare team before returning to exercise.

You should not drive until you can control your vehicle, including in an emergency. You should check with your insurance policy and healthcare team before driving after your operat

What are the benefits of LINX® reflux surgery?

There have now been several research studies published that have examined the safety and efficacy of LINX® up to 5 years after surgery. These have consistently shown the following:

• Significant and maintained reductions in reflux symptoms.
• The normalisation of acid exposure in the oesophagus.
• Significant improvements in quality of life.
• Most patients remain off medication.
• Significantly fewer side effects than those caused by fundoplication operations.
• A low complication rate.

The LINX® implant results in pH normalisation, improved quality of life, and complete cessation of regular PPI (Proton Pump Inhibitor) in the majority of patients. The ability to belch and vomit is LINX®maintained after the implantation of LINX®, and post-operative moderate to severe gas-bloat is uncommon. When compared with laparoscopic fundoplication, rates of success in alleviating GORD (Gastro-Oesophageal Reflux Disease) symptoms and dysphagia are similar following the LINX® procedure. Bloating side effects are lower. Longer-term follow-up data demonstrates that the LINX® Management System is effective in the management of GORD (Gastro-Oesophageal Reflux Disease).

What are the side effects of LINX® Reflux Surgery?

Side effects following the LINX® System procedure are minimal and generally resolve over time.

Mild dysphagia (difficulty swallowing) occurs in less than half of patients after the procedure and is generally resolved within 90 days without treatment.

Unlike other surgical treatments, the LINX® System does not have the side effect of restricting belching and vomiting.

Does the effect last?

Studies have indicated that the LINX® may be more durable than the fundoplication, but definitive evidence is currently lacking.

What about recovery following surgery?

Surgery to insert the LINX® system is less invasive than a fundoplication. The majority of patients can leave the hospital on the same day as surgery if they wish to.

The LINX® System starts to work as soon as it is in place. Patients should be able to resume a normal diet within a few hours of surgery and can usually return to normal activities in less than a week.

What are the possible complications of LINX® Reflux Surgery?

While all surgery carries the risk of complications, the LINX® System procedure does not involve any changes to the anatomy of the stomach and is fully and easily removable. The first LINX® Reflux Management System procedure took place in 2007. In the time that the procedure has been performed, there have been no reports of the device migrating from the site of implantation.

Complications are rare, they include:

• Hernia
• Bleeding
• Visceral injury

The LINX® removal rate is 2-3% globally but less than 1% in RefluxUK patients, removal is straightforward if necessary with no change to the patient's anatomy. LINX® removal is usually because of persistent dysphagia or lack of effect.

Removal is performed during a keyhole surgery and is usually straightforward.

Erosion of the device into the oesophagus has been reported but seems to be a far smaller risk than initially feared. The evidence suggests this can occur between 1 in 750 and 1 in 1000 patients. When it does occur the LINX® can be removed with another minimally invasive procedure and seems to cause no long-term damage.