ach around the esophagus, the essence of 360-degree Nissen fundopli-
cation, can result in future complications, such as rapid emptying of
the stomach, difficulty swallowing and excess gas. There's also the
possibility that the portion that's wrapped will loosen or slide over
time, and that the surgery will fail as a result.
Alternatively, the LINX procedure involves placing a metal ring with
magnetized titanium beads around the lower eshophogeal sphincter.
Once it's in place, swallowing breaks the magnetic bond, allowing
food to pass, but the magnets then pull together again, creating a bar-
rier to reflux.
On the bright side, that means there's no manipulation of the anatomy
of the gastroesophageal junction, which is important. But the concept
raises questions about the long-term viability and safety of the ring. Is
there a risk it will migrate or erode into the esophagus? The procedure
hasn't been around long enough to give us 15 or 20 years of follow-up
review.
Significant failure rate
Ultimately, there's no magic bullet. A large-scale study
(osmag.net/8xjwdh) from Sweden recently published in the Journal of
the American Medical Association found an 18% failure rate among
patients who'd had fundoplication surgery between 2005 and 2014.
Those patients either remained on medication after 6 months or
required additional surgery.
Although the numbers don't surprise me, I am surprised that so
many surgeries failed so quickly. There may be several explanations,
but again, ultimately what I suspect the results reinforce is that the
procedure requires expertise and considerable experience. That, I sus-
pect, will lead to increased popularity for the LINX approach, because
it reduces failures associated with loosening and other anatomical
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