Nissen versus Linx

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SummerGAL
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Date Joined Apr 2011
Total Posts : 116
   Posted 4/3/2012 11:20 PM (GMT -6)   
You may not create a link to this website from another website or document without Weight to Go Limited's prior written consent.  Edit:  I took out the Linx info as I could not delete the post.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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


ericapeace2000
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Date Joined Mar 2012
Total Posts : 967
   Posted 4/4/2012 9:06 AM (GMT -6)   
Linx seems promising. I wonder when insurance will cover it.

Raj2011
Regular Member


Date Joined Mar 2011
Total Posts : 64
   Posted 4/4/2012 9:28 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

bcfromfl
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Date Joined Nov 2011
Total Posts : 384
   Posted 4/4/2012 9:36 AM (GMT -6)   
Until the studies become available of actual hard numbers, the Linx, and anyone's hopes/expectations of it, should be underscored with a healthy dose of skepticism. The comparisons outlined in the chart are not much more than anatomical/engineering differences.

The questions candidates should be asking include:

Are there studies/results showing before/after pH tests, hopefully separated by symptom category? Proximal? Distal?
Were participants in the studies prequalified by symptom category, i.e., typical vs. atypical symptoms?

Also, does the constant tension on the surgical site by the magnetic ring impact circulation, like the elastic band of a sock around an ankle?

The Linx may very well be a good alternative for GERD patients. But I see more excitement right now for a new device, and blind hope, rather than hard questions being asked.

-Bruce

stkitt
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Total Posts : 32601
   Posted 4/4/2012 9:55 AM (GMT -6)   
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
~~Kitt~~
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GERD/Heartburn and Heart/Cardiovascular Disease.

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"Life is not about waiting for the storms to pass...
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speden
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Date Joined Oct 2009
Total Posts : 165
   Posted 4/4/2012 1:37 PM (GMT -6)   
> Also, does the constant tension on the surgical site
> by the magnetic ring impact circulation, like the elastic
> band of a sock around an ankle?

There were no reports of this happening in the clinical trial. The Linx is very different from something like a rubber band. A rubber band would apply constant pressure which could cut off circulation and make it very hard to get food past it. By contrast the Linx stops contracting once the magnetic beads come in contact with each other. It also has better opening characteristics than a rubber band since magnetism decreases greatly once the beads separate. So it behaves a lot more like a functioning valve that opens and closes than a rubber band would.

bcfromfl
Regular Member


Date Joined Nov 2011
Total Posts : 384
   Posted 4/4/2012 1:48 PM (GMT -6)   
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

speden
Regular Member


Date Joined Oct 2009
Total Posts : 165
   Posted 4/4/2012 2:12 PM (GMT -6)   
Bruce,

I think they tend to opt for a loose rather than a snug fit. If you go for a snug fit, the risk of dysphagia increases and it would also probably make it difficult to burp. Even with fundoplication, they go for a loose fit around the esophagus. The insides of the esophagus do not need to be pressed firmly together to stop reflux. The Linx procedure uses a sizing device to get the correct ring diameter for a given esophagus.

You can see some discussion of this from the Torax Conference from last year at the 1:50 mark:

www.youtube.com/watch?v=TBCeyw6iUWI

bcfromfl
Regular Member


Date Joined Nov 2011
Total Posts : 384
   Posted 4/4/2012 3:17 PM (GMT -6)   
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

opnwhl4
Forum Moderator


Date Joined Dec 2008
Total Posts : 4814
   Posted 4/4/2012 5:03 PM (GMT -6)   
One point I would like to make is that the Nissen is reversible. It can be taken down.

Take care,
Bill
opnwhl4
Moderator: GERD/Heartburn
Nissen 6/06 and 5/09
#3 on 8/24/11

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 3416
   Posted 4/4/2012 5:50 PM (GMT -6)   
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.

SummerGAL
Regular Member


Date Joined Apr 2011
Total Posts : 116
   Posted 4/4/2012 9:58 PM (GMT -6)   
Sorry about not posting the link - learning the rules.


I talked to my Surgeon today and he said he will not use the linx because there is just not enough long term data!

SL  
 

Post Edited By Moderator (stkitt) : 4/5/2012 9:22:18 AM (GMT-6)


speden
Regular Member


Date Joined Oct 2009
Total Posts : 165
   Posted 4/5/2012 10:02 AM (GMT -6)   
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

stkitt
Forum Moderator


Date Joined Apr 2007
Total Posts : 32601
   Posted 4/5/2012 10:24 AM (GMT -6)   
Sl,
 
I had to edit your link as the site has a copyright on their website:
 
"You may not create a link to this website from another website or document without Weight to Go Limited's prior written consent."
 
No problem.
 
Kindly,
Kitt
~~Kitt~~
Moderator: Anxiety, Osteoarthritis,
GERD/Heartburn and Heart/Cardiovascular Disease.

www.healingwell.com

"Life is not about waiting for the storms to pass...
It's about learning how to dance in the rain."~ Vivian Greene

hitThePost
Regular Member


Date Joined Dec 2011
Total Posts : 133
   Posted 4/5/2012 12:50 PM (GMT -6)   
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.....

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 3416
   Posted 4/5/2012 9:38 PM (GMT -6)   
Dr Luke, or possibly his residents, did mine. My op note said he was present for all major parts of the surgery. He doesn't do Linx anymore because it wasn't as reliable as nissen type surgeries. You can look up several very good papers just by putting his name in the search engine.

Dr. Luke is a great surgeon, no bedside manner. I never saw him the day of surgery or thereafter. He doesn't make rounds after surgery. His crew is superb. They are very experienced, have done thousands and do a fantastic job. I wouldn't hesitate to have his crew do surgery again if I need it.

hitThePost
Regular Member


Date Joined Dec 2011
Total Posts : 133
   Posted 4/6/2012 1:33 PM (GMT -6)   
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....

hitThePost
Regular Member


Date Joined Dec 2011
Total Posts : 133
   Posted 4/8/2012 3:44 PM (GMT -6)   
Alcie, are you in PA as well? I am in the York, PA area, but travelled to see Dr Luketich's staff - specifically Dr Levy - for a potential Nissen. If I go through with either surgery, that will be the group as they seem to have SO much experience with these things. I am going through testing confirmation and treatment for Eosinophilic Esophagitis prior to, or if, I having/have surgery.

Were you on PPi's? If so, how long? I was on Nexium for 2 years or so, but that stopped working and I have been through Protonix, Prilosec, Dexilant....and now I am on Zegerid as the prior 3 didn't work at all. Zegerid seems to work somewhat, but I am only on 1 40mg daily, and I refuse to take more. I also rotate in 75-150 mg Zantac nightly, along with liquid Carafate.
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