LINX Procedure (Anti Reflux Surgery)

What is the LINX procedure?

  • Magnetic Sphincter Augmentation (MSA), also known as the LINX procedure, is a surgical treatment for acid reflux
  • It involves placing a magnetic ring made of titanium beads at the bottom of the oesophagus.
  • The magnetic force helps keep the oesophagus closed to prevent reflux but allows it to open when swallowing.

Benefits of Surgery

  • Provides relief from acid reflux symptoms.
  • May eliminate the need for long-term medication.

Alternatives to Surgery

  1. Lifestyle changes:
    –     Avoid trigger foods, especially before bedtime.
    – Raise the head of the bed.
    – Lose weight if overweight.

  2. Medication:
    – Proton pump inhibitors (PPIs) reduce stomach acid and help heal inflammation.
    – Medication is the first-line treatment and often effective.
  1. Other surgery:
    Fundoplication surgery is another option, also effective for long-term reflux control.

Linx is not usually recommended if:

  • You’re under 21 years old.
  • Your BMI is over 35.
  • You have a large hiatus hernia.

Your surgeon will help you weigh the pros and cons of each option before making a decision.

What the LINX Procedure Involves

  • The operation is done under general anaesthetic and usually takes less than an hour.
  • Laparoscopic (keyhole) surgery is used, involving small incisions for faster recovery, less pain, and minimal scarring. In rare cases, open surgery may be needed.
  • A small cut near the belly button is made to insert an instrument and inflate the abdomen with gas (CO₂) to allow space for the operation.
  • Several small cuts are made to insert surgical instruments and a telescope to see inside the abdomen.

During the procedure:

  • The liver is moved aside to access the upper stomach and lower oesophagus.
  • The surgeon frees up this area and uses a tool to measure the oesophagus to select the right size LINX device.
  • A magnetic ring of titanium beads is placed around the bottom of the oesophagus and locked in place to help prevent acid reflux.

Additional step (if needed):

  • If there is a large gap in the diaphragm (linked to a hiatus hernia), the surgeon may stitch the diaphragm to reduce the gap, improving symptoms and lowering the risk of future hernia.

• Finally, the instruments are removed and the cuts are closed.

How do I prepare for LINX Surgery?

  • Maintain a healthy weight – Being overweight increases the risk of complications.
  • Your surgeon may recommend a special diet 2 weeks before surgery to shrink your liver, reducing bleeding risk and making surgery safer.
  • Exercise regularly – This helps with preparation, recovery, and long-term health. Check with your GP or healthcare team before starting new exercises.

To reduce infection risk in the surgical wound:

  • Do not shave or wax near the surgical area in the week before surgery.
  • Take a bath or shower the day before or on the day of surgery.
  • Stay warm – Let staff know if you feel cold.
  • If diabetic, keep blood sugar levels controlled around the time of surgery.

What are the potential risks or complications of the procedure?

General Surgical Complications:

  • Bleeding during or after the procedure, rarely requiring a blood transfusion.
  • Hernia formation at the surgical site, which may require further surgery.
  • Infection at the wound site, treatable with antibiotics but sometimes requiring special dressings.
  • Venous thromboembolism (VTE) – Blood clots in the leg (DVT) or lungs (pulmonary embolism), which can be serious.
  • Chest infections, particularly in smokers or those recovering from COVID-19.
  • Adhesions (scar tissue) leading to bowel obstruction, possibly requiring another procedure.
  • Allergic reactions to medications, materials, or dyes (rare but possible).

Keyhole Surgery Complications:

  • Damage to internal structures (e.g., bowel, liver, blood vessels), which may require open surgery (risk: <3 in 1,000).
  • Surgical emphysema (trapped gas in the skin) or gas embolism (rare but serious).
  • Conversion to open surgery if keyhole surgery is not possible.

Specific Complications of LINX Surgery:

  1. Pneumothorax
    Air leak into the space around the lung which occasionally requires a chest drain to remove the air.
  1. Perforation (hole in oesophagus or stomach)
    – Happens in about 1 in 100 cases.
    – Needs surgical repair and possibly a drain. May result in a longer hospital stay.
  1. Device Erosion
    – The LINX device can wear through the oesophagus wall (1 in 1,000 cases).
    – A serious complication requiring another surgery to remove the device.
  1. Liver Damage
    Occurs when the liver is moved during surgery (5 in 100 cases)..
  1. Spleen Damage
    – A rare complication.
    – If it occurs, the spleen may need to be removed.
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What are the consequences of LINX Surgery?

Short-Term Consequences:

  • Pain: Common in the first 48 hours post-surgery. Shoulder pain may occur due to gas (CO₂) under the diaphragm from keyhole surgery. Pain meds will be provided.
  • Scarring: Small scars from surgery, which may be unsightly in some cases.
  • Difficulty swallowing (Dysphagia): A common and temporary side effect 2–12 weeks post-op, peaking around 3-6 weeks. Caused by healing around the magnetic beads.
    Best managed by eating solid food regularly to help the device function and tissue to heal. Eat at least 5–6 small meals daily, ideally having a few bites of food every hour, chewing well and taking small bites.

Long-Term Problems (less common but possible):

  • Persistent dysphagia (difficulty swallowing): Affects about 15 in 100 people. Bread and meat may be harder to swallow.
  • Reflux symptoms may persist if the device moves or fails.
  • Weight loss in the first 2 months: You may feel full quickly and eat less. Usually temporary.
  • Diarrhoea: Affects fewer than 3 in 100 people. Medication may help.
  • Adhesions (scar tissue): Tissues in the abdomen may stick together but rarely cause major issues.

Recovery after LINX Surgery

In Hospital:

  • After surgery, you’ll be moved to recovery and then to the ward.
  • You’ll be given anti-sickness medication.
  • Start with soft foods on the day of surgery, and return to your normal diet the next day.
  • You should no longer need acid-reducing medication.
  • Many patients go home the same day, though some may need to stay longer depending on the surgeon’s advice.

Returning to Normal Activities:

  • Blood clot prevention: Follow instructions on medication or compression stockings if provided.
  • Diet: Resume a normal diet the day after surgery.
  • Work: Most people return to work after a few weeks, depending on recovery and job type.
  • Manual tasks: Avoid heavy lifting or manual work for a few weeks.
  • Exercise: Encouraged to help recovery, but get advice from your GP or healthcare team before starting.
  • Driving/riding: Don’t drive or cycle until you’re fully able to control the vehicle in an emergency. Check with your healthcare team and insurance provider first.

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