Almost everyone has dealt with heartburn or “gas bloat” at some point in their life. Maybe you ate something too spicy, drank too much coffee, or maybe the medications you’re taking are leaving a bitter taste in your mouth. If this is happening consistently, you may be suffering from GERD. GERD, or Gastroesophageal Reflux Disease, is a condition that affects millions of people worldwide. It can be incredibly frustrating, with symptoms or side effects such as heartburn and discomfort that can disrupt daily life. This article aims to provide a comprehensive understanding of the LINX procedure, its impact on GERD, and its relationship with weight loss.
What is LINX Surgery?
The LINX Reflux Management System is a small device that’s implanted around a muscle called your lower esophageal sphincter (LES), located at the end of your esophagus near your stomach. You have GERD because your lower esophageal sphincter muscle isn’t working properly. The problem is that your muscle isn’t closing all the way when food enters your stomach. The LINX device stops partially digested food in your stomach from flowing back up into your esophagus, thus relieving GERD symptoms.
The LINX procedure is a minimally invasive surgery that offers several benefits over traditional open surgeries. By using small incisions, the recovery time for patients undergoing the procedure can be greatly reduced, leading to a faster return to normal activities. Unlike some other procedures, the LINX procedure does not alter the anatomy of the stomach. This means that if necessary, the LINX device can be removed, allowing the patient’s natural anatomy to be restored.
How the LINX Device Works
When placed around the lower esophageal sphincter (LES), this innovative device helps to strengthen the LES and prevent stomach acid from going back up into the throat. The device acts as a safety belt, keeping stomach acid in the stomach where it belongs. The magnetic beads help to strengthen the LES and keep it closed when it should be. When you swallow food or drink, the magnetic beads temporarily separate and allow passage into the stomach. Once the food or drink has passed, the beads come back together, keeping the LES tightly closed and preventing any acid from escaping.
Who is Eligible for LINX Surgery?
Individuals between the ages 21-75 with typical symptoms of gastroesophageal reflux such as abnormal stomach pH are considered eligible for the procedure. If you’ve been struggling with GERD symptoms despite attempts to manage them through lifestyle changes and medications, you may be exploring other options for relief. Factors such as the severity of your symptoms and the underlying cause of your reflux can play a role in determining whether LINX is the best treatment for your unique situation. The LINX surgery should stop the need for antacid medications such as Nexium, Protonix, or Prevacid.
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LINX Surgery and Weight Loss: Is There a Connection?
It’s crucial to understand that LINX surgery is not a weight loss surgery. The primary goal of the LINX procedure is to treat GERD by stopping the backward flow of stomach acid into the esophagus.
Weight loss is a journey that can be challenging for many people, especially those who struggle with obesity. However, there are several surgical procedures available to help those who are struggling to shed pounds. This is done by reducing the size of the stomach or altering the way food is absorbed in the digestive tract. These procedures aim to restrict the amount of food the stomach can hold or reduce the absorption of nutrients from the food. While the primary goal of these surgeries is to combat obesity and related health issues, some patients may notice an improvement in their GERD symptoms as a result. However, it’s important to understand that weight loss surgeries are not specifically designed to treat GERD.
Potential for Weight Loss After LINX
Most people will lose 10-15 pounds after surgery depending on what they choose to eat. This weight loss is more likely attributed to dietary changes and adjustments during the recovery period rather than a direct effect of the LINX device itself.
Post-Operative Diet and Recovery
We want people to resume a normal diet immediately following surgery and you will be asked to eat a sandwich or equivalent before you leave hospital following your surgery. Swallowing may be temporarily worse around 2-4 weeks. Each patient tolerates different consistencies at different times of their recovery, and some patients have no difficulty swallowing after surgery. Gradually increase your diet over the next weeks as your body permits. To stretch the scar tissue please eat a normal diet immediately following surgery, as this will be equivalent to doing physio on your gullet. This can be uncomfortable at times, but is the most important part of your recovery, so keep doing it even if uncomfortable. You may also have 3-4 snacks between meals per day. It takes 30 seconds for the oesophagus to regain its strength after a swallow. If food seems to be hanging up, slow down and wait at least 1 minute between bites. Large bites are likely to have a harder time going down and are more likely to lead to spasms or hiccups. During regular meals still follow the 1 bite every minute principle. Warm or room temperature liquids tend to be more comfortable than cold. Cold liquids lead to the weakest pressures (meaning more difficult for things to go down). Small sips frequently are helpful to prevent dehydration.
A few weeks after surgery (generally 2 weeks), swallowing always gets worse as the inflammatory process following surgery peaks and then settles - this is normal. At this time scar tissue temporarily thickens and most of the healing process occurs. Swallowing may become much more difficult during this time, but continue to eat normal meals and, if you want, small snacks between these. Please let us know if you are not able swallow yogurt consistency most (over 50%) of the time. After a few weeks this should improve. Swallowing should slowly improve after 4 weeks.
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Dietary Recommendations After LINX Surgery
- Day of Surgery: Soft Foods: A soft diet is recommended only for the day of LINX placement; a regular diet can be started the day after. In general, a soft diet is “anything you can squish through your fingers,” but you can also start trying slippery noodles, whitefish, and soft, cooked vegetables that are chewed well. Avoid rice, bread, chicken, and lettuce, as these things tend to be harder to swallow.
- Weeks 1-2: Regular Food: Take small bites of food. Chew food very well. Eat frequently: five to seven small meals per day or a small snack every one to two hours. Minimize the amount of dry food intake (i.e., chips, hard bread, crackers).
- Weeks 3-8: Dysphagia Timeframe: Scar tissue will be forming at this time. You may experience some difficulty swallowing, increased belching, or chest pain. You should continue eating frequently, as eating often alleviates these symptoms. If you experience food “sticking” or difficulty swallowing, drinking warm tea or other warm liquids will help by relaxing the esophagus.
General Rules to Follow
- Maintain an upright position (as near 90 degrees as possible) whenever eating or drinking.
- Take small bites, only ½ to 1 teaspoon at a time at first.
- Eat slowly. It may also help to eat only one food at a time.
- Avoid talking while eating.
- Do not mix solid foods and liquids in the same mouthful, and do not “wash down” foods with liquids, unless you have been instructed to do so by your surgeon.
- Eat in a relaxed atmosphere, with no distractions.
- Following each meal, sit in an upright position (90-degree angle) for 30 to 45 minutes.
- Avoid carbonated (bubbly) drinks; they will make you feel bloated.
- If food does stick, don’t panic. Try to relax and let the food pass on its own.
Addressing Common Post-Operative Symptoms
It’s totally usual in the first weeks after surgery to experience all sorts of symptoms. Many people think their reflux has returned, they can get chest pain and even oesophageal spasm mimicking cardiac pain, hiccups and repeated burping, odynophagia (pain when swallowing) and throat symptoms including those mimicking LPR. Hiccups are most often due to fluid and/or food that has not passed out of the oesophagus. Typically, they will stop in a few minutes. If you find that you are regurgitating saliva or liquids, this is usually due to their building up in the oesophagus. Especially saliva (foamy stuff) has a hard time being cleared by the oesophagus. Saliva and liquids tend to build up between meals and before going to bed. Some patients experience spasm (chest tightness that can take your breath away) during the recovery period. Typically, this will last a minute or so. Spasm is most often due to food getting stuck in the lower oesophagus though sometimes will occur spontaneously. Although it can be very uncomfortable, it is not serious, and the frequency and severity will decrease as time goes by. Some patients will feel heartburn symptoms after surgery. It is very unlikely this is due to reflux. Heartburn can occur with oesophageal irritation of any type including surgery - not just acid reflux. Heartburn can also occur after drinking acidic liquids (e.g., lemonade) that do not clear immediately after swallowing. Regurgitation during the recovery phase is reflux of fluid within the oesophagus, and not from the stomach. Do not be alarmed if this happens, it should resolve as the swelling goes down and swallowing improves.
Important Considerations After Surgery
You may take your normal prescription medications. If you are still having problems swallowing them, you can check with your pharmacist and see if you can crush or break them. In general, you may resume normal non-strenuous activities as soon as you are up to it. Aerobic activities are tolerated if you can speak in full sentences. If you cannot complete a full sentence without taking a breath, you are working too hard. Sometimes patients will experience shoulder pain or deep pain in the chest after surgery. This is due in part to the gas used at laparoscopy, but more so to the sutures placed in the diaphragm muscle; and should gradually resolve. Heat applied to the shoulders tends to help this pain the best. It may be difficult/uncomfortable to take a deep breath or lie flat immediately after surgery as breathing uses the diaphragm muscle. This will slowly improve as you heal from surgery. You may be given a prescription for a narcotic pain relief and/or anti-inflammatories and anti-nausea medication. Please speak to the Pharmacist at the hospital if you have any queries prior to your discharge. You may resume other medications you were on prior to surgery.
Wound Care
You will have typically 4/5 small incisions between your belly button and your rib cage. The incisions can be closed in a number of ways with an absorbable stitch, surgical skin glue or Steri-strip (paper suture), generally these will be covered with a water-resistant dressing of some sort. You may shower or bathe. Avoid placing oil lotions on the glue and it will gradually peel off over time. Sometimes a swelling and/or a lump under the incision will develop and is part of the natural healing process; you need not be alarmed unless there is drainage more than a plaster will handle. Bruising may occur here too.
When to Seek Medical Advice
It is very unlikely you should need acid-suppressive reflux medications after surgery. If in the future someone wants to prescribe reflux medications for you, or you are concerned your reflux is back, please let us know. Please call the office when you return home from the hospital to schedule your follow-up appointment.
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