LINX Surgery after Sleeve

[jenp7 3]

Has anybody had the LINX surgery after sleeve? I am 6 yrs post op sleeve. The last 2 months I have had GERD and PH of esophagus is too high. I also have a vital hernia. My Options is Repair Hernia, then LINX placement or Gastric Bypass. I need some help to decide.

[RickM 1,753]

If you haven't run into this in your research, I found this to be an interesting point/counterpoint discussion of the LINX (the "Yes" vote is linked at the bottom).

http://agaperspectives.gastro.org/is-linx-the-way-to-go-for-gerd-surgery-no/#.X7K6SWhKiUk

I also found another source that indicated that LINX was not appropriate for bariatric patients, but didn't explain why (possibly simply because that group didn't have much experience with bariatric patients?) The "No" vote above did lift out the prospect of erosion from the foreign body, and given the history of the lapband, that is probably a good point of caution.

I would suggest getting a second (and possibly third) opinion on this. I am a fan of second opinions, particularly when it comes to revisions and complications, as both the causes and solutions are often more varied than the original surgery, and hence the opinions as to the best way to go often vary more widely - what one doc is comfortable doing to solve the problem may not be the ideal for you, while another doc may have different experiences that allows him to offer something better for your need. Or maybe not - but as patients it is hard for us to evaluate, but one solution may make more sense to us than another.

I have found that with the sleeve, being a relatively new procedure to most of the bariatric world, the solutions to problems that may crop up are often limited - some docs are limited to simply revising to a bypass as they don't have much experience with anything else. Most bariatric surgeons here in the States are fairly well experienced with the sleeve by now (as opposed to 6-10 years ago) but may not yet have that much experience in correcting problems with them, which is why it can pay to seek out alternate opinions. Sometimes there are shape issues with the sleeve, stemming from either the original surgery or from subsequent evolutions, and surgeons can vary widely on their ability to address these. Some can do fundoplications to address the hiatal hernia, while others can't (there isn't that much fundus to plicate after our VSG.)

I would suggest a second opinion from Dr. Ara Keshishian, who does a lot of complex revisions (people come from across the country to see him, particularly as he is one of the few who can do the RNY/DS revision) and if anyone can get things working better without a major revision or devices, it is him. If one can avoid an RNY or an implanted device, that would be ideal. Conveniently, he is right around the corner from you in the Glendale/Pasadena area.

I do have a hiatal hernia, though a fundoplication is inappropriate for my case, and as GERD is mild and well controlled with moderate OTC meds, and EGD shows nothing exciting happening, it is a wait and see thing for me at this point.

Hope yours comes out well, whatever path you take,

[jenp7 3]

Thanks for your input. I've decided on Dec 8, to just repair my hiatal hernia and not the LINX placement. I do not want a RNY at this time. Hoping by putting my sleeve back where it should be will fix reflux. It has only been in the last 2 mos that reflux has bothered me. Some days feeling real nauseous or just burping a lot. I do not have any burning. I'm 6 yrs post op and I now do think I've had some reflux over the last few years. Hasn't been bad and just took OTC antacids. I've just had a Upper Endoscopy with a BRAVO placement to check on reflux. Numbers were high. Have Esophagitis. GI doctor gave me a med called DEXILANT. It is working very well. I for sure will keep Dr. Keshishian for future reference. Thanks again.

[valiemet 3]

I’m in the same boat. I have LPR (silent refiux). I’ve have acid come out my nose, vomit and have aspirated it into bronchial tube. It’s everyday. One surgeon says hiatal hernia fix and another says hernia fix and Linx. I’m leaning toward just fixing hernia. Did it work from you?

[jenp7 3]

I had my hiatal hernia repair on DEC 8. It worked out so well, no more reflux. Feeling great. I'm so glad I decided against the LINX. Even my doctor said I made the right choice. Do the repair first. If it works, great. If not, then you can go to another plan. Even if it clears up some, you'll feel better. Good Luck.

[valiemet 3]

Thank you! I’m happy it worked! Did you have a weak LES? GI said I do

[KateinMichigan 24]

On 1/20/2021 at 12:55 AM, jenp7 said:

I had my hiatal hernia repair on DEC 8. It worked out so well, no more reflux. Feeling great. I'm so glad I decided against the LINX. Even my doctor said I made the right choice. Do the repair first. If it works, great. If not, then you can go to another plan. Even if it clears up some, you'll feel better. Good Luck.

Yes!!! Congratulations! Could you share your HH surgeon?