Linx Procedure 2017 My Experience

Hi, tgal102-

We have a similar history. I had a lapband from 2003-2012. I converted to the gastric sleeve in 2012 and began to have issues with reflux in 2014. I cannot tolerate PPIs or H2 blockers so I consulted a surgeon that year who told me my only choice was the bypass. So I underwent bypass surgery in December 2014. My reflux was back by February 2015. The surgeon basically blew me off, telling me it was physically impossible for me to have reflux, but there it was. Tests proved I was still refluxing and then I was diagnosed with Barrett's Esophagus. I went back on the PPIs and suffered horribly with the side effects. I had my bypass revised with my original bariatric surgeon (wish I had gone to him in the first place) and still did not solve the reflux problems.

My personal belief is that when I had the lapband and did not always eat properly, the LES got stretched out like an elastic waistband. Now it simply does not work properly any longer. So the LINX device will basically be like putting in new elastic- good as new.

I have found a surgeon and am scheduled for surgery one month from today. I wish I had never had the bypass and had gone straight to the LINX, but at the time, I had never heard of it (plus my insurance won't cover it and only one person in the whole state does the procedure and it is a 5 hour drive to get there). So I will travel out of state for surgery but my surgeon is one of the most experienced in the country so I will be in good hands. I am hoping that my insurance will cover this doctor and my paraesophageal hernia repair (the LINX will be done at the same time as the repair) but if it will not, I will be taking out a loan to get the procedure done. I would have done it already, but waiting until then fits into my schedule better.

Anyway..... I wish you the best as you decide how to proceed!! From my personal experience, I would skip the bypass and go directly to the LINX. I have heard of other people who have successfully cured their reflux issues with the bypass, but I wonder how well their LESs were functioning. I think that probably makes all the difference.

Sue D'Nem

Hi, Chad!

I am hopeful that I can work out something similar if they do not get on the multi state network in time. I am pretty sure they will work with me. My insurance will not cover the LINX at all but I do have the paraesophageal hernia too so the plan is to bill the insurance for that procedure alone. I know my insurance would cover emergency surgery and a paraesophageal hernia can be an emergency, but would it be an emergency procedure if I already have it scheduled? Hmmmm..... I am thinking that the payment plan would be my best course if the insurance won't cover. We will see what happens.

Sue

The esophigical manometry test sucks. Its the worste test I had to take. Be prepared for that train wreck. Well it was for me at least some have done ok. As far as cost, that different for every state and hospital. Is so with a guess the procedure was $7000 without insurance and hospital was another $25,000. I think I pay out 400 a month in total with small pieces going to each facility

Good afternoon all,
I am currently on day 4 of recovery from hiatal and umbilical repair and installation of the Linx. I did 1 night in the hospital, Monday 2/26, and home Tuesday afternoon. I am a 59 yo female employed full time. Because of my job I routinely pick up 50 lb bags of carrots, onions, etc. The umbilical repair was a re-repair. Blew the last repair week one back to work. I think my Linx is healing well. Started food slow. Yogurt, grapes and applesauce. My worst problem was constipation. Started stool softeners and laxatives, high fiber diet, a lot of water the day I got home. Still no luck till today. Still taking meds and making sure I get enough fiber. Have had some esophageal spasms but had those before surgery. The muscles don’t always work correctly. I am so far still in a good bit of pain, but happy I did go ahead with the surgery. I already have less burning in my esophagus. Wish I had this before the acid killed by back teeth.

linx0026

glad to hear your doing ok. take it slow. i did not have constipation, that usually is from the anastheia and pain meds. Pain meds for sure cause it, you may need some milk of magnesia to get things moving. you will feel those spasms for a bit, i think i had them for 2 months. it was kind of scary but eventually everything settles down. like most millennials and i wanted to feel better now, but this is a process!

Linx 022618

Hi. I agree with Chad that milk of magnesia, should help with the constipation. I am 1 month out from my surgery and used milk of magnesia twice a day and it really helps. Too bad constipation is a major side effect of pain meds, so as long as you are on those, you may get constipated.

You may want to read about my experience I shared today and on Feb. 24, 2018, on Chad2322. I have had really good results so far.

Good luck to you.

Thanks again Chad!

I had Linx and a hiatal hernia repair about 4 weeks ago. While I am not a surgeon (and the below is NOT FORMAL MEDICAL ADVICE), I have some doctor friends and did an enormous amount of pre-surgery research. Below is what I learned, I hope that it is helpful to someone.
Preop: Hydrate well. Drink lots of water the night before and 8oz up to 2 hrs before surgery (unless your surgeon tells you otherwise).
Anesthesia: You don't want to be nauseaus after surgery and general anesthesia makes many people very nauseaus. I would recommend asking your anesthesia provider if they are comfortable with giving you a scopolomine patch and/or TIVA (pronounced tee-vuh) both will decrease the chance of nausea. Another medication they can give during surgery to lessen nausea is Decadron, but be aware that Decadron can mess with your blood sugar and (if you are like me) can make it very difficult to sleep the first night. On to constipation - it is common after surgery, so limiting opiate pain medications during surgery can help with this (and with nausea as well). You can ask your anesthesia provider if they are comfortable limiting your intraoperative opiates by administering a medication called ketamine. Ketamine isn't for everybody and can cause some bad dreams, but when given at the beginning of surgery tends not to have pronounced side effects.
Postoperative pain: Don't be afraid to ask your surgeon to put some local in your inscisions, it helped me to not have to worry about inscisional pain until after the car ride home. For me, the worst postop pain was the shoulder pain from the gas they used during surgery. My surgeon friend said that moving around was the best way to get rid of the gas, so I made sure to get up an walk a little ever hour or so and the shoulder pain only lasted a couple of days.
Postoperative dysphagia: Eat early and often. My surgeon recommended every 30 minutes while awake. This is to decrease scar formation around the device which can be a long term problem. Dysphagia tends to start around day 7 after surgery, but if you had a hernia repair it can actually start right away (which I wish I had known ahead of time!). Before surgery, if food got stuck, I would take a big gulp of water to get it down. This does not work anymore, it actually just makes things worse and hurts like hell! For me, sips of water before and after well chewed food works best. While it is tempting, avoiding difficult-to-swallow foods is not a long term solution if you want to regain (relatively) normal swallowing. The way I'm lookng at it is that eating is physical therapy and physical therapy is going to be uncomfortable for the esophagus just like it would be for an orthopedic issue.
Last week I went back to work about 3 weeks after surgery and, even though I was up to walking a couple of miles during the time off, the first day back still kicked my butt.
Personal results: I still get reflux, but only about 30% of what it used to be and I am sleeping much better! It would be nice to have no reflux, but I have some esophageal hypersensitivity, so that would probably not be a realistic expectation.
Well, I hope the above knoledge is helpful for you and good luck!

Post Edited (Taterium) : 3/4/2018 8:14:19 AM (GMT-7)

I've been suffering with acid reflux and a hiatal hernia for the past 40 years, on meds for probably the last 20 years and my GI has been milking the insurance for the past 10 years by pushing 2 drugs daily and having me come back every 4 months. My last scope came back with abnormal cells and he still did nothing but say see you in 4 months.

During my physical last December my primary doctor recommended a surgeon that specialized in abdominal surgery and GERD. I put it off until I had a real nasty night time aspiration, choking on acid and vomit. A couple months before I was talking to a woman at work who's father had the Nissan 10 years ago and he's been off the meds and fine since then. That got me thinking. After a second bad aspiration a week later I decided to call my primary doctor for a referral to the surgeon. The surgeon ordered 3 GERD tests that should have been done years ago by the GI!!!

3 weeks ago I did all of the nasty tests. Got the results yesterday. Doctor recommended the LINX. He's installed over 60 in the past 2 years, only 1 had to come out.

Today I've been doing reading about the LINX. Not thrilled with complications that last for many months. I've been a "Hoover" eater all my life. I open my mouth and the food disappears into me. Having a poorly functioning LES makes it easy to get the food down, but just as easy for it to come up. This is going to change how I eat forever. But that's a good thing. I'm probably 30 lbs overweight. I expect I'll lose that in the next few months.

Waiting on the approval from the insurance. Hoping to have the surgery in April.

Ok so interesting turn of events. Since linx implant I've been reflux free acid free etc. Well, I weighed I think 170 ish pre surgery, I got down all the way to 153 post surgery, now I've worked my butt off in gym increased calorie, I've managed gain around 15 lbs in 3 months so I'm weighing 168 as of today. I no longer look sickly. However, since. Three days ago I noticed a a ver scary all to familiar feeling. Acid burning, I felt reflux.. O I'm gonna loose my crap if I start experiencing herd after everything I've been through. So I took a zantac and poof, burning gone. I'll keep you guys updated. But my research found that excess weight gain can or increase in stomach size increase the pressure in the stomach and press against the linx. So I'm going to slow down on wasteful fatty eatting. Has any1 heard of this or experienced it.

Birdmom,
I noticed your post and might suggest seeing if you qualify for the EndoStim trials taking place. I failed my test for the Linx, so found this option and had this surgery performed in Germany 1 1/2 years ago. The results have been nothing short of exceptional. This option should be considered if possible. From the comments I read, the recover is much easier, since there is no swallowing issue to be concerned with. Since I failed my swallow motility tests and had a hiatal hernia so I didn't qualify for the trials, so I went to Germany for the surgery. If you qualify for it, it is really a great option to consider. The EndoStim was approved in Europe and elsewhere first due the high cost and time of the FDA. Success rates are over 91%, and with the doctor I used, he was running a 100% success rate with the EndoStim implant.
From what I have heard, swallow motility improves in many cases, no concern for dysphagia.
Last I heard there are about 60 slots still open in the trials.
Worth checking out.

PuppetMan

LinxLauren,

HANG IN THERE. i too went through the same thing. I ended up in the emergency room one day by myself with nurses starring at me wondering what to do. I had lost like 7 to 8 lbs, i couldnt get food or water down, my surgeon was on vacation. But they gave me fluids which i actually think saved my life, not being pretentious. Any and all foods were sitting on the linx and not passing. Luckily, my surgeon returned, we did a barium swallow and then immediately did they balloon dialation. after the dialation i was swallowing normal and felt as if everything was working as it should.

Good news is your reflux and acid is gone, now just to weather the storm of what i tell people is the most challenging part and under discussed topic regarding this surgery. Has your doctor mentioned a balloon dialation?

Now, i posted a week ago about feeling reflux, it went away after a couple of zantac. My one constant is bloating. February 7th this year marked my one year post op. Since then at least several times a week i get a mild to severe bloating. Sometimes causes nausea but sometimes just feels like your going to pop. It will ruin the day until it resolves. Sometimes passing gas helps, and warm baths, if not, the day is shut down. I plan on speaking with surgeon but what can he really do or say at this point, he already got so aggravated with me in the beginning that he looked at me and said ok well are you ready to just take it out, we can schedule.

Hang it Lauren

Hey Lauren,

Yes, stress. My god i thought it was just me. If i get stressed, which i do a lot as i suffer from GAD general anxiety disorder. Ive noticed when im stressed its harder to get food to pass, its almost like the tense and pressure from stress makes its way to the linx. I did the same as far as smaller snacks but i started losing weight really fast, couldnt work full days at my job etc. Now that i think back, the first 2 or 3 days out of surgery i had no dysphagia, then it just came on really quick and relentless. It would start with wretching noises. Anyways, being in the medical field you know better than most, stay hydrated and if i can help let me know. Gosh im looking out my window trying to think of something that i did that will help you but i had really gave up i had no more fight or waiting it out- the dialation worked for me. Im sure you have seen this link but its got some interesting stats http://www.surgery.usc.edu/uppergi-general/gastroesophagealrefluxdisease-linx-risksbenefits.html

Hi, All!!

Had my LINX surgery last week. Here are my thoughts and experiences:

It has been one week since surgery. I had to travel out of state to have my surgery and arrived to snow and otherwise horrible weather conditions the evening before my surgery. I was hoping the bad weather was not an omen! The morning of surgery I had to be at the hospital at 5:30 a.m. as I was the first surgical patient of the day. I had to clear about 6 inches of white fluffy snow off the rental car before we could leave. I packed comfy clothes for surgery. I was not prepared for winter weather!!

Got to the hospital and got checked in and over to the pre-op area where I had a yellow gown and yellow socks but not the same shade of yellow. It was gross because, well, yellow is not the greatest color. The nurse hit the IV on the first try. This is a HUGE thing for me because they never hit on the first try!!! (I once had them not get an IV started until the 6th try…… for me, the IV is worse than the surgery itself). Vitals all checked, met with the doctor, met with anesthesiology, and away we went to the OR. As always, freezing in the OR. I remember moving from the gurney to the table and then I don’t remember anything at all.

I do not remember much following surgery. I know I was in a post-op area for a while and then moved to a different space where my family member was invited back. I got dressed and ate some pudding (yum) and talked with the doctor. I am sure he explained everything he did but the only thing I remember is asking about the size of the LINX and him telling me it was a 17, the largest size. That concerned me a bit because what if it is too loose….. but I decided not to worry about it and trust that the doctor’s judgement was best and go with it.

My surgery consisted of moving through scar tissue of several previous surgeries, repairing a large para-esophageal hernia, placing of the LINX device, and checking to see all went well. I have no idea how long the surgery was but I was ready to leave the facility and really wished I was going home rather than the hotel. The worst thing that happened was the discharge nurse very carefully going over the post-op diet information….. for the Nissan Fundoplication. This would not have been a problem because I knew what the plan was for post-op eating, but when your family member is there for the briefing, she is disinclined to believe the person who just had surgery and really wanted me to follow the WRONG eating plan.

Back at the hotel I slept most of the afternoon with a heating pad. My shoulders hurt A LOT, particularly the right one (most people have pain in the left shoulder). I had my family member do some massage and actual pounding on my shoulders with her fists. It helped. For dinner that first night, I convinced her that I could eat grilled fish and mashed potatoes (that was a hard discussion because the wrong diet said no potatoes for 5 weeks). I took tiny bites, chewed well, and I don’t think food ever tasted as good as that fish and potatoes did!!

The next morning I was back at the hospital for a barium x-ray and a follow up appointment with the doctor. Everything looked good on the x-ray and my appointment was quick and sweet. I am sure I will think of a million questions to ask the doctor as I go along, but they are really wonderful about answering emails. So far, my questions have been insurance issue questions. The doctor put in a pre-authorization for the hernia repair, not the LINX. My insurance company denied the LINX procedure so I have appealed on the fact that the doctor did not request the LINX but the hernia repair. I am not asking the insurance company to pay for the LINX, just the hernia repair. Whatever else I have done is between me and my doctor and is frankly none of the insurance company’s business. But the hernia repair is something that is covered by my insurance and was medically necessary and should be covered in full by them. If my doctor and I chose to have the LINX placed at the same time on my own dime that is my business. So we will see what happens with the appeal. It went out in the mail today.

I wish I had flown home that second day. I was in agony from the pain in my shoulders and I would have been much more comfortable in my own bed. But at the same time, I was really glad I did not have to manage luggage and the airplane and everything travel related until the next day. I flew home really early on Thursday morning and was so happy to back in my own bed by noon that day!! I did some house cleaning, grocery shopping, and other normal life stuff with no problems over the rest of the week. I took very little in terms of pain meds and generally only at night and went back to work yesterday (Monday), not quite a week after surgery. I have a desk job so being at work was actually less strenuous being at home and doing stuff around the house.


In terms of recovery, the first couple of days were the worst. I was in pain that the meds and the heating pad were not relieving and I could only lay on my back elevated on pillows. I was bummed because I wanted to sleep on my side (my right side specifically since I have not been able to do that without refluxing for years) and I wanted to be flat. The first night back home I was able to sleep on my side and slept really hard and well. I have noticed that in my life I have avoiding bending over as much as possible because I would reflux. I can now bend down without problems (well… none except the twinge from the incisional sites). Over the weekend I took the blocks out from under the head of my bed so now my bed is no longer at an angle. I have slept well every night but one since I have been home. No reflux, no aspiration, no waking up in a panic because I feel like I am drowning from the stuff coming up and trying to go back down the wrong pipe!

Food wise I have been eating regularly, once every hour or so. I was going to be so good and organized and have an alarm set so I would remember to eat every hour on the hour but I have not done that. I am now trying to eat something during each hour time period but not necessarily exactly one hour apart (something during the 6 o’clock hour, something during the 7 o’clock hour, etc.) and it seems to be working for me. I have pretty much eaten whatever I want and have only had issues when I do not focus on small bites chewed well….. and pasta…. So I will wait a while before adding it back in. I have not gone all out eating things I could not eat due to reflux. I have not had tomato based soups or sauces, alcohol, or coffee yet so I cannot speak to whether or not those thing will be back in my diet yet. Probably not on a regular basis because I have gone a long time without them and can live without. But it will be nice to be able to have a drink now and then without knowing in advance that I will have a horrid night of reflux as punishment. In terms of food getting stuck, for me it is not really painful, but it is very uncomfortable. I try to burp and that usually dislodges whatever is stuck and lets it pass through. If it is not going down, it has to come back up. This is really not like vomiting. When I had a lapband years ago it was called a productive burp because you would burp back up what was stuck and it would be fine. It is not vomit because the food has not made it past your LES and has no stomach acid or other digestive juices. It is just the stuck item and spit. Drinking something can help too, but I have found that it will either go down with a burp or it will come back up. I try to avoid the coming back up by taking small bites and chewing well, but sometimes I am not as focused on my eating as I should (especially eating as often as I am now…. Gotta eat and work at the same time sometimes). For people who are worried about surgery because of getting things stuck and throwing up: it is not really like that at all. And it is really avoidable if everything is working properly if you take small bites, chew really well, and focus on eating while you are eating. It is really a matter of learning to listen to your body. It will teach you what you need to do. If you are a good listener and learn quickly, you will have fewer problems. If you keep trying to shovel in too much food too fast, you are going to be uncomfortable and maybe in pain.


Another issue I am having is eating every waking hour. I formed a habit of not eating after 7 p.m. (6 if I could) and I really do not want to let go of that habit. I CAN eat closer to bed time and not have reflux, but I know I feel better and sleep better if I stop eating further out from bed time. So I am trying to balance the two opposing forces, at least during the healing phase. When I am further out I can and will go back to not eating after 7 p.m. so the food can be further along the digestion track before I go to sleep. The key in healing is exercising the LINX and the LES so the scar tissue does not form too tightly. That is the purpose of eating often: push food through to keep the function the way it is supposed to work.

Anyway…… this is my “I’m a week out” report. I have no regrets except not doing this sooner!! I have not had any reflux nor have I taken any meds for it since the night before surgery. I was not taking PPIs or H2 Blockers but I was on Carafate and OTC TummyZen (great stuff…. Try it!!), tums, and gaviscon. Not taking any of it and really glad about it too!

Bottom line, I 100% without hesitation recommend the LINX surgery to combat GERD and Bile Reflux. I also have Barrett’s Esophagus and erosive esophagitis. I look forward to having an endoscopy this summer with my local GI folks and showing them healing without PPIs and the horrific side effects I had from them. But PLEASE, go into surgery informed and know what to expect post-op. I have had a pretty easy time, but I also knew what to expect. Some of the things I read where people are ready to have the device removed within a month of having surgery indicates to me that no one gave them a realistic expectation of how things will be. This device is forever. You will not be able to eat large, improperly chewed bites of food ever again. You WILL have to FOREVER adjust the way you eat. This is not a bad thing and is certainly better than dealing with reflux. Ultimately you might find that there are foods you cannot reasonably eat with the LINX device (so far pasta is a no-go for me…… I love pasta….. but gee….. I can live quite nicely without it if it means no more reflux….. and maybe later in my healing I will be able to eat it again….. but if not, it is still better to do without than deal with reflux).

I am sorry this is so long and I am sorry that it is going to be a repeat post in many different forums. But I did want to share the information about how I am doing so far in my journey and give other people hope that there is a way to solve the reflux problems without taking PPIs forever.

Take Care!!
Sue