I am a surgeon who operates on patients to treat their GERD, and I am also a patient who has suffered from GERD for a number of years. With over 20 years in practice as a Board Certified General Surgeon and Fellow of the American College of Surgeons, I have seen the pain and suffering that results from the progression of acid reflux disease. As a GERD sufferer myself, I’ve experienced that same pain. What I’ve learned as both a surgeon and as a patient is important: antireflux surgery works, and it is a valuable treatment that every adult struggling to manage their acid reflux disease should consider.
Antireflux surgery is not new; in fact Dr. Rudolf Nissen created the first advancement in the treatment of severe esophagitis in the 1950s with a novel new approach that bares his name today, Nissen fundoplication. This procedure creates a “wrap” around the lower esophageal sphincter (LES) using a portion of the upper stomach. I have performed this procedure hundreds of times, and it is considered the “gold standard” by surgeons today because it has proven itself over 60 years.
In March 2012, the FDA approved a new surgical procedure, the LINX® Reflux Management System, that augments the LES. Using magnetized titanium beads, the LINX device dynamically opens and closes, mirroring a healthy LES. One element I appreciate about LINX is the fact that this device is not permanent, thus it can be removed if the patient is not satisfied with the device. The five-year results have been very positive, and there is strong data today suggesting that it can compete with the gold standard.
When I discuss antireflux surgical procedures with my patients, I focus on three important characteristics of each surgery; 1) the effectiveness of the procedure in stopping reflux; 2) the side effects associated with each procedure, and; 3) the speed and ease of a patient’s recovery. On the first characteristic, the long-term history of a Nissen may suggest it is superior; however the most recent data about LINX is very strong. RefluxMD, a GERD community website, summarized those result in an article titled New Study Finds LINX Effective for Chronic GERD. Evaluating the side effects associated with these two procedures, the LINX has a clearl edge. Unlike LINX, a Nissen does not allow patients to burp and vomit, and Nissen patients have a noticeable incidence of dysphagia, increased bloating and flatulence. Finally, the patient’s recovery following a LINX procedure is shorter with less pain than a Nissen.
Like many suffering with GERD, for many years I took omeprazole to treat my heartburn. Unfortunately, it didn’t alleviate other symptoms including some upper abdominal discomfort and bloating, nor did it help with ever-increasing issues of hoarseness and throat clearing (LPR). Although I wasn’t completely happy, I didn’t think my symptoms were severe enough to merit surgery.
Two things changed my perspective. First, I started getting recurring bronchitis from some nighttime aspiration. Second, I saw how effective the LINX surgery was with my patients and their overall delight with this procedure. As a result, in March 2015, I underwent the LINX procedure to treat my GERD by a colleague in California. I underwent all the testing I ask my patients to go through, and I experienced the identical recovery process. I had postoperative pain in the shoulders (it was pretty bad the first day) and some issues early on with spasm and swallowing. As a result, this experience has made me more sympathetic and encouraging to my current patients during their surgical journey. Likewise, I am now able to offer more individualized suggestions to patients based on my own recovery and understanding of physiology.
I am thrilled that I had the LINX surgery, and I have not required any medication since the surgery. As a surgeon I’m delighted that we can offer new technologies to patients and that I have walked the same path they are on. Some of my patients do not qualify for LINX surgery, and I am always comfortable recommending other surgical procedures. However, whenever possible, I like to offer all treatment options available for my patients to consider. At the end of the day, the surgical decision is always my patients’ – just as it was for me.
– Reginald Bell MD