Nissen versus Linx

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Post Edited By Moderator (stkitt) : 4/5/2012 9:28:47 AM (GMT-6)

This analysis missed an important point - LINX will implant a foreign object in the body permanently, and patient cannot have any MRI's done.
Raj

Saleen

The info you provided appears to be copied and pasted from another website.  Please post your link to this information as it may be copyrighted. 

Thank you for your cooperation.

Kitt

I think we are both correct, speden.  There has to be some tension from the magnetic ring in order to prevent reflux past the surgical site.  The stomach churns contents in regular, peristaltic contractions, and if the ring were loose enough such that no tension was placed upon the surgical site at "rest", leakage would occur.

In a perfect installation, the magnets would meet each other at just the point that the insides of the LES are pressing firmly closed.  (Even at this stage, there would be pressure on the exterior of the esophageal wall.)  But, with all the possible variances in thicknesses of tissues, the surgeon probably opts for a snug fit.

Is this of concern?  Maybe not, but I'd like to see more discussion of this.  Even a rubber band reduces tension as the stretching of it ceases, and, as I see it, the Linx is just a durable elastic band with defined open/close points.

-Bruce

Thanks for the link, speden. One thing that struck me about this video is the surgeon's caution about separating the vagus nerve from the esophageal wall, to slip the Linx underneath. His belief is that it is OK to leave the vagus nerve attached, and install the Linx around the outside. At this stage of the game, this discrepancy concerns me. Which school of thought is correect?

One of the advantages touted in defense of the Linx is that it doesn't take as much skill from a surgeon as does a Nissen. Based upon what this surgeon said (and I believe he confessed that he had only done three), I wouldn't agree to a Linx from a surgeon who had had a weekend training course, or even performed three or four dozen. This sounds to me like a procedure that requires considerable experience...the nature of which a surgeon would have from doing hundreds of Nissens.

You're not paying a surgeon for his experience in following a step-by-step procedure out of a textbook. You're paying him for experience if/when he encounters something NOT in the textbook.

-Bruce

There is no question of choice if you have a hiatal hernia that needs to be corrected. I trusted my docs to make the right decision for my individual case. They have a 98% or so success rate with Nissen over many years and do re-dos of other procedures often. When the new types of surgeries were all in vogue 15 year or so ago, they tried them out and came back to the types of Nissen.

While it's not fun having a Nissen, I wouldn't take the chance with a new procedure until it gets a better rate of success. My docs made the final decision during surgery, and based the choice of a Toupet (partial Nissen) on my tests, length of esophagus and other technical measures.

Bruce, as far as I know the current recommended procedure for implanting the Linx is to create an opening between the vagus nerve bundle and the esophagus and to insert the Linx through the opening. That probably has the advantage of helping to hold the Linx in place and not putting any pressure on the vagus nerve. Possibly that's not needed, but there's no clinical data on that so far. From the clinical trial I didn't see any reports of damage to the vagus nerve from the Linx implantation procedure, but if the surgeon makes a mistake of course it could be damaged. These nerves are very important and unfortunately are sometimes damaged during fundoplication, which requires a lot more tissue dissection than the Linx procedure.

The initial doctors for the Linx are likely going to be the ones that participated in the clinical trial, so they have some experience with the procedure. Usually a surgeon would be trained and supervised on the procedure before being authorized to perform it on their own, so there's more to it than just handing them a textbook.

From what they have said so far, they are not in a hurry to push the Linx to a lot of doctors. In one of the videos from the conference I remember someone saying they were concerned that as the Linx becomes more widely used, general surgeons without a lot of experience with digestive system anatomy might make mistakes. If I were looking for a Linx surgeon, I'd want one that had a lot of experience with fundoplication and also experience with the Linx.

You might find these other videos from the conference interesting (these are from about a year ago):

www.youtube.com/watch?v=YUoAPIgxxzE
www.youtube.com/watch?v=wHXi23nppR4
www.youtube.com/watch?v=qU86Hj4g8E0
www.youtube.com/watch?v=OwBmyPGO0Zo
www.youtube.com/watch?v=DkWH_TdW-No

Does anyone here have experience with Dr. James Luketich @ UPMC in PA? He is pretty well-known for Nissen's and I noticed he was part of the Linx trial and is listed as an Implant Center on the Torax site.....

Thanks for the info. Not sure whey they would have put him on the site, then? I know he was part of the trial, but you would figure they would take his name down if he refused to do them....