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Quote njd2 Replybullet Topic: Linx vs Fundo
    Posted: 04 Aug 2017 at 1:25pm
Hi all

I have HH of 2 CM and 5cm Barretts.

Due to ongoing symptoms and the fact that medication doesn't seem to help I have been recommended for surgery.

I was going with a Fundo, however I have recently heard about Linx - I can't find much by way of articles on Fundo Vs Linx....can anybody here provide any advice as which to go for?

Linx sounds better as it doesn't involve altering my stomach - though is it as effective?

Has anybody had Linx? Any recommendations for surgeons in the northwest?

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Quote chrisrob Replybullet Posted: 04 Aug 2017 at 6:13pm

Read more about linx in the Down With Acid book here.
As the chapter says, it has had much publicity - through heavy marketting. But is it as effective as Fundo?

Laparoscopic Nissen Fund0lication is still the gold standard with 90% very pleased they had it. Linx has an approval score of 85%.

My personal views on Linx vs Nissen are summarised below:

LINX pros:
Its ring of magnetic beads help close the lower oesophageal sphincter.
The surgery for this is slightly less invasive and slightly shorter than for LNF and there is less (internal) healing for the body to do. It has been available for nearly 15 years. The operation is minimal and patients can go home the next day with some able to go home the same day. You can eat normally afterwards.
If it doesn't work or goes wrong, it can be removed and LNF performed instead.
A "long term" study over 6 years (with a mean implantation time of 3 years) of 100 recipients showed 85% of them no longer required daily PPIs for acid reflux and were glad they had had the procedure.

LINX cons:
It costs over twice as much as LNF.
It cannot be used in everybody (depends on presence of Barrett's and hiatus hernia). It doesn't repair a hiatus hernia. (A temporary repair of a small hernia may be affected but it can easily reherniate.)
If needed, MRI scans can only be at low power. MRI can displace magnets or create induction heating.
63% of recipients experience swallowing difficulties. A solid enough bolus propelled with sufficient peristalsis is required to open the device.

LINX unknowns:
Will it migrate or erode the adventia (outer wall of oesophagus) over time? 40 years ago, a new device was being enthusiastically embraced. Angelchik was effectively a broad gel rubber band / collar attached around the oesophagus that kept the oesophagus closed by elasticity. However over a long period, it's movement against the adventia caused gradual erosion. Migration and erosion issues occurred causing a clamour of patients having it removed.
As you will see at the end of the Down With Acid page on Linx, there have now been cases of migration reported.

LNF pros:
It is the gold standard for reflux reduction surgery.
Nissen fundoplications have been used for 60 years with surgeons becoming more expert and techniques improving all the time. It has been performed laparoscopically for over 20 years.
The operation is minimal with patients usually able to go home the next day (and some on the same day as their operation).
It uses natural body tissue with similar elasticity to the organ it surrounds.
A recent study of nearly 200 patients who had LNF 20 years ago found 94% satisfaction with it.
There is no risk of erosion or migration.
Any hiatus hernia will be corrected and the Nissen wrap prevents it from recurring.
It can be performed if the patient has Barrett's.

LNF cons:
85% of patients experience problems with burping or vomiting whilst the scar tissue heals.
50% of patients have swallowing difficulties while the scar tissue heals. Soft foods are required at first but you can eat normally within a few weeks.
In the 20 year study, the wrap had failed in 18% of patients, when it can be redone. (Newer techniques mean that failure rates are now estimated to be only around 5%.)
NHS is far more likely to provide Nissen. LINX is too expensive but can be had on NHS if a good enough case is made for it.

Linx may look shiny and sexy but you don't see it once implanted - and it was originally developed for faecal incontinence - the Fenix device.
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Quote njd2 Replybullet Posted: 07 Aug 2017 at 1:32pm
Thanks, I guess with my Barretts I'm unlikely to be able to have linx anyway and it sounds like a less tempting option based on the above.
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Quote Mtmurray Replybullet Posted: 08 Aug 2017 at 5:00pm
My surgeon (one of the best in the mid west, USA) wouldn't do lynx if you had Barrett's. He would only do a fundo. I'm 16 mo post op and I take no meds anymore. I have zero symptoms and life is the most normal it's been in the past decade. Best wishes on the decision you choose
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