April 5, 2019 – Imagine getting rid of your acid reflux, protecting
your health and improving your quality of life in just one hour. That’s
the premise behind LINX® Reflux Management System, a laparoscopic
procedure that eliminates the symptoms caused by Gastroesophageal Reflux
Disease (GERD). In December 2018, board-certified surgeons
Vincent K. Arlauskas, M.D. and
J. William Tsai, M.D. of
Southeast Georgia Physician Associates–Glynn General & Vascular Surgery, began performing the LINX procedure at Southeast Georgia Health System.
The lower esophageal sphincter acts as a barrier between your esophagus
and stomach. By opening and closing, it allows food and liquid to enter
your stomach when you swallow. When it ’s weak or distorted by a
hiatal hernia, stomach acid backs up into your esophagus, creating heartburn
and a host of other problems.
Unfortunately, chronic reflux and medications to manage GERD can lead to
serious health issues. Short term, reflux affects what and when you eat,
your voice, your sinuses and how well you sleep. Over time, damage from
stomach acid can lead to esophageal cancer. Proton Pump Inhibitor (PPI)
drugs to control GERD aren’t a good long-term solution, since they
leach important nutrients from the body, increasing your risk of osteoporosis.
It’s also thought that PPIs could cause kidney and coronary disease.
“Often when I meet patients for the first time they don’t know
that there are other options beyond medication,” says Tsai.
According to Arlauskas, the first steps toward relief are simple. “We
try all the conservative measures first – diet, lifestyle modifications,
medication. If reflux persists, patients are screened with an endoscopy,
pH testing and manometry to determine if they qualify for surgery. These
tests measure acidity levels as well as the health of the esophagus.”
How LINX Works
The LINX procedure uses a flexible ring about the size of a quarter. Made
of magnetic beads, this ring is surgically implanted around the esophagus
just above the stomach. Once it’s placed, the device strengthens
the sphincter and prevents reflux. The surgery does not alter the stomach
anatomy and because the device is flexible, it allows normal bodily functions,
such as belching and vomiting. This differs from Nissen fundoplication,
the traditional GERD surgery, which restricts some bodily functions. LINX
may also help reduce gas and bloating.
If the patient has a hiatal hernia, the surgeon repairs the hernia before
implanting the ring. The LINX procedure requires general anesthesia and
takes about an hour. Most patients go home after one night in the hospital
and resume their normal routine and diet within a few days. In fact, many
enjoy foods they previously couldn’t tolerate with GERD. The device
is designed to last a lifetime, but if it needs to be removed for any
reason, revision surgery takes less than an hour.
Outcomes and Considerations
“There will always be a place for fundoplication, but LINX is becoming
more popular because it’s a more elegant way to treat the problem,”
The device has demonstrated good outcomes since being FDA-approved in 2012.
According to the manufacturer, in a study of 100 patients, 85 percent
no longer depended on daily medication after surgery. A follow-up study
found that 99 percent were free from regurgitation and 88 percent were
free from heartburn a full five years after surgery.
“The main side effect with LINX is dysphasia (difficulty swallowing),
but within three months of surgery, there’s less than one percent
chance of that,” says Arlauskas.
Another concern, MRI compatibility, has been largely resolved. The device
is compatible with the newer MRIs found in 94 percent of hospitals in
America. And although every patient is given an implant card to carry
in their wallet, going through airport security does not present problems.
If a patient has chronic heartburn symptoms that don’t respond to
lifestyle changes or medication or they just want to avoid the risk of
taking PPIs, LINX may be a viable option. The screening tests help determine
if the esophagus is sufficiently wide enough to perform the surgery and
whether a hernia exists. If a hernia larger than 3 cm is present, it must
be repaired before getting the implant.
With reflux resolved, patients are surprised how much better life can be.
“A middle-aged patient of mine had hernia repair many years ago.
When she began experiencing reflux and pain again, I converted her fundoplication
into a LINX. Two months later, she has no pain, no reflux and she’s
off medication,” says Arlauskas.
Tsai shares his colleague’s enthusiasm. “You don’t have
to be on PPIs for life, and there’s no need to travel to larger
cities for care. We now have cutting edge endoscopic and surgical GERD
solutions available right here in the Golden Isles.”
To find out if you’re a candidate for LINX, call 912-265-5125 to
schedule a consultation.