GERD & the LINX Procedure After Bariatric Surgery
April 5, 2017Tomato sauce, coffee, and onions. If you’re wondering what these foods have in common, you probably don’t regularly suffer from heartburn or acid reflux. If you do have reflux, you instantly recognized these foods as ones that you probably can’t eat without unpleasant consequences. This is just one of the many ways acid reflux gets in the way of enjoying life.
Medications can help, but when should you start to think about a more permanent solution than a lifetime of meds? The good news is now there are safe and effective surgical fixes for acid reflux – even if you’ve had weight loss surgery and have been told there are few options.
Understanding Acid Reflux and GERD
Let’s take a look at why reflux occurs in the first place. Acid Reflux, or gastroesophageal reflux disease (GERD), occurs when acids “back up” from the stomach into the esophagus, causing a burning sensation in your chest. Being overweight puts you at a higher risk of GERD. Losing weight, along with other lifestyle changes such as quitting smoking, can help with symptoms.
Many bariatric surgery patients find their reflux symptoms get much better after weight loss. However, in some cases, particularly for Gastric Sleeve patients, GERD can worsen. There is research that shows GERD can develop in a very small percentage of patients who did not have it prior to Gastric Sleeve (VSG) surgery. Over-the-counter antacids or prescription medications help to reduce the amount of acid in your stomach. Medications do not cure acid reflux.
This is because GERD is not caused by an overproduction of acid. It is due to a weak muscle at the bottom of the esophagus, called the lower esophageal sphincter (LES). The LES acts like a one-way valve, allowing food to pass into the stomach.
Normally, the LES closes immediately after swallowing to prevent your stomach juices from backing up into the esophagus. When the LES is weak, acid flows back into the lower esophagus, causing irritation and inflammation that may eventually damage the esophagus.
Heartburn is one symptom of reflux disease that most people have at some point in their lifetime. Frequent reflux can lead to potentially serious complications, such as esophagitis (damage to the lining of the esophagus), a narrowing of the esophagus known as a stricture, or even cancer.
Some people are born with a naturally weak sphincter. For others, it may relax and weaken over time. Additionally, a hiatal hernia or weakness in the muscles surrounding the lower esophagus contributes to the development of acid reflux.
When to Consider Surgery for GERD
Patients in my practice who are interested in a surgical solution to GERD typically have the same thing in common. They are tired of taking medications that don’t completely control their symptoms. In addition, often they are concerned about recent studies that linked long-term use of reflux medications, known as PPIs, with a higher risk of dementia and heart disease. If that sounds like you, you may want to consider minimally invasive surgical treatment for GERD.
LINX Reflux Management System - Approved by the FDA in 2012, LINX is the newest surgical option for patients suffering from GERD. LINX has many benefits over traditional anti-reflux surgery. LINX is a flexible ring of small magnets (about the size of a quarter) that are placed around the LES during a minimally invasive laparoscopic procedure. The magnets help the weak LES to open when it should (while swallowing food) and close when it should, preventing reflux.
In a 2016 study, up to 85% of patients were free from dependence on daily reflux medication after their treatment with LINX. In addition, LINX requires no permanent changes to the anatomy. This is especially important for post-op Sleeve patients whose only prior surgical option was to convert to a Gastric Bypass (RNY). This is a conversation you should have with your bariatric surgeon to determine the right course of action.
Laparoscopic Nissen Fundoplication - The traditional anti-reflux surgery for GERD, Nissen Fundoplication is a minimally invasive laparoscopic procedure that involves fixing your hiatal hernia, if present. It wraps the top part of the stomach around the end of the esophagus (like a hot dog in a bun) to reinforce the LES. Due to the nature of the surgery, this is a not an option for post-op Sleeve patients. Your doctor will determine if you are a candidate.
Conversion to Gastric Bypass from Sleeve Gastrectomy - For Gastric Sleeve patients only, a conversion to a Gastric Bypass may be beneficial if you suffer from GERD and are not satisfied with your weight loss from your initial surgery. Again, speak to your bariatric surgeon, who will determine if you are a candidate.
Minimally invasive anti-reflux procedures have short recovery times, allowing patients to return to work quickly. As with any surgery, anti-reflux procedures are associated with potential surgical risks that your surgeon will review with you. If you think you may be a candidate for any of these procedures, have a conversation with your bariatric surgeon who will help you determine the best options for your specific case.
 | ABOUT THE AUTHOR Glenn Forrester, MD, FACS, is a bariatric and general surgeon at New Jersey Bariatric Center, with offices in Springfield, Hoboken and Somerville, NJ. He is also Director of Bariatric Surgery at Robert Wood Johnson University Hospital, Somerset Campus, in Somerville, New Jersey. In addition to being a leading bariatric surgeon in New Jersey, he is one of the first surgeons in the state to perform the LINX procedure for reflux. |
