New LINX Procedure at Twin Cities Advances Treatment for Reflux Disease
Gastroesophageal reflux disease(GERD) causes discomfort and disruption. The LINX procedure is an effective way for GERD patients to get their lives back. Dr. David Bolivar, general surgeon at Twin Cities Community Hospital, discusses how LINX works.
Featuring:
Dr. Bolivar earned his Bachelor of Science from La Sierra University in Riverside, California. He completed both medical school and general surgery residency at Loma Linda University. After completing his training, he joined the Associated Surgeons of San Luis Obispo in 2002. He has been published in the Journal of Trauma.
Dr. Bolivar is a member of the Society of Laparoendoscopic Surgeons and the American College of Surgeons.
Dr. Bolivar and his family enjoy outdoor activities and he is an avid tennis player.
David Bolivar, MD
Dr. David Bolivar is a general surgeon with a broad spectrum of general surgery and a special interest in minimally invasive surgery, specifically surgeries for acid reflux. He previously served as Chief of Surgery at Twin Cities Community Hospital and chairman of the Cancer Support Community.Dr. Bolivar earned his Bachelor of Science from La Sierra University in Riverside, California. He completed both medical school and general surgery residency at Loma Linda University. After completing his training, he joined the Associated Surgeons of San Luis Obispo in 2002. He has been published in the Journal of Trauma.
Dr. Bolivar is a member of the Society of Laparoendoscopic Surgeons and the American College of Surgeons.
Dr. Bolivar and his family enjoy outdoor activities and he is an avid tennis player.
Transcription:
Prakash Chandran (Host): Gastroesophageal reflux disease, otherwise known as GERD, can be extremely uncomfortable and disruptive in one’s daily life. Luckily a procedure called LINX is an effective way for reflux patients to get their lives back. Here with us to discuss is Dr. David Bolivar, a general surgeon at Twin Cities Community Hospital. It’s a pleasure to have you here today Dr. Bolivar. So I want to start with the basics because this may be foreign to a lot of people, including myself, but what exactly is gastroesophageal reflux?
Dr. David Bolivar (Guest): Gastroesophageal reflux, otherwise known as GERD, happens when stomach acid flows back from the stomach into the esophagus, and many people call this heartburn or reflux or just feel this uncomfortable feeling coming back into their chest or up even to the back of their mouth. So unfortunately this is a very common thing that happens to many people.
Host: So this is – it’s good that you make that clarification because you’re saying that the general acid reflux or heartburn that people experience on a day to day basis or when I have too much ice cream for example, that is an example of gastroesophageal reflux?
Dr. Bolivar: Yes, that is correct.
Host: Okay, so in the past I think people have tried to heal themselves by maybe taking some Tums and potentially if it gets really bad, going to see their doctor. Can you talk a little bit about what has been tried in the past and what has worked to help combat this?
Dr. Bolivar: Absolutely. So whenever anyone has gastroesophageal reflux, we always try to start with the minimally invasive manner, so lifestyle modification is what works the best. Eating smaller, more frequent meals, avoiding inciting foods, sometimes losing weight if someone’s overweight can be helpful. If that doesn’t work then adding medication, like you mentioned with Tums or the classification of stronger antacid medication can be sometimes helpful. Sometimes for all sorts of different reasons, that doesn’t work. People have their reflux symptoms of the heartburn go away but still fluid is still coming up into the back of their throat or going down into their lung and they really look for different alternatives, and that’s when we kind of fall into the surgical aspects of it.
Host: So let’s talk a little bit more about the surgical aspects of it. What are some surgical ways or procedures that you use in today’s medicine to help combat this reflux?
Dr. Bolivar: So for decades the traditional operation was called a Nissen fundoplication, which as an operation that if somebody has the hiatal hernia that we would fix that, bringing the hiatal hernia, if the stomach was up in the chest, we kind of bring it down into the abdomen, and then also wrap the stomach around itself and around the esophagus, so it would create in essence a one way valve. So things went down but they didn’t go back up. So this operation has been around for a long time, and it works really well with preventing gastroesophageal reflux. One of the downsides of it is that it’s a bigger operation and then also it’s not a great operation for things to be able to go back up if it needs to. So if someone ate too much or feels bloated or feels like they need to throw up, sometimes it can be difficult with that operation, called a Nissen fundoplication. So that would kind of segway us over to a newer procedure. It’s been around for actually quite a while in the world, but in 2012, the FDA approved this procedure called the LINX and the LINX is a procedure that laparoscopically, meaning through small little port sites, under anesthesia, we put a magnetic ring around the esophagus that has some flexibility. So if people ate, it is able to open up and allow food to go down, but then also keeps food from coming up. The really kind of exciting and cool thing about the LINX is that it’s a little bit more – it makes people back into their normal state. In that if you ate too much or you feel like you’re sick to your stomach, it does allow you to be able to vent the stomach, either be able to burp or throw up if you really need to. So that’s what the exciting thing is about it.
Host: That does sound really exciting and if I can just try to break it down in laymen’s terms, I’ll do my best here, it seems like that acid reflux happens when the acid from the intestine goes back up the tube when it’s not supposed to, right? So what the LINX is, I was just looking at some pictures online, it almost looks like a little bracelet, right? That goes over and restricts the ability for the acid to go back up, and it is – how does it expand and contract? Like what is it? Is it flexible? Is it a magnet? How does that work?
Dr. Bolivar: Yeah exactly, so it’s like a little bracelet, and it’s a titanium ring, but each of these titanium beads are held together. There’s small magnets in them, and with that, the magnets bring it back together at a resting state, but then when you eat you’re able to break that magnetic hold and then that’s what allows it to relax and open up and then go back down to it, kind of closed state when you’re not eating.
Host: The advancements are truly amazing, and like you said, unlike the original procedure that you were used to doing for so many centuries, this actually contracts when you do need to, for example, throw up or kind of get something back down. So it seems like it restricts at the right time and it also un-restricts itself when you need it. Would you say that’s accurate?
Dr. Bolivar: Yes that is correct.
Host: So I want to get into the proper candidate for the LINX treatment. Is the LINX treatment or procedure good for everyone? Who’s the best candidate for this?
Dr. Bolivar: So the best candidate is someone that traditional – the best candidate is the one that traditional methods for relieving their acid reflux has actually worked. So if someone takes medications and it works, but they want to get off the medication, they’ve tried lifestyle modifications, they’ve lost weight, and they’re just sick of having reflux, they’re not wanting to take medications anymore and just not having to worry about this, those are the ideal candidates. There are many other candidates for this, people that have secondary problems because of reflux. Sometimes people can have bleeding or severe irritation of their esophagus or it causing strictures or narrowing or a lot of other secondary problems, and those are candidates also. Before anybody would be able to have any type of operation, there is some preoperative testing that needs to be done to make sure that the operation itself will actually help and not make another condition worse.
Host: So is this considered a minimally invasive procedure?
Dr. Bolivar: It is. This is definitely a minimally invasive procedure. Even though it’s in the operating room done laparoscopically through small little incisions that are less than an inch in size, and most people are able to go home the same day as their operation.
Host: Yeah, that was the next question that I was going to ask you, what the recovery time was like. So even though they’re able to go home the same day as their operation, what are they feeling afterwards? How long does it really take to kick in and start working?
Dr. Bolivar: There’s a few phases of recovery after this procedure. Initially you’re just sore because of the operation you just had. So for about four to seven days you feel your incision sites and they kind of hurt. That slowly kind of goes away and you start feeling better. With the LINX procedure, you have this magnetic ring around your esophagus and you start to form some scar tissue around it. So the essence of it is people need to get on an eating regimen of eating small meals every few hours to make sure that your esophagus is opening up and closing and the LINX is opening up and closing. It’s almost like physical therapy for your esophagus and the thing that you want to do is to make sure it’s opening and closing so that long term it doesn’t get stuck closed. So that’s the biggest thing that we talk about with patients about keeping this moving early on.
Host: And what does that look like, keeping it moving early on? It seems like this is something that’s been approved, it’s been around for long enough, but how do patients when they’re recovering make sure that it’s actually opening up the way that it’s supposed to?
Dr. Bolivar: It’s by eating small meals somewhat frequently throughout the day, every two to three hours or so and the act of swallowing and having food going down through the esophagus opens that up. You don’t feel the LINX opening or closing. Early on after surgery, sometimes people can have that feeling like food is getting stuck a little bit, but after swallowing once or twice, that goes through, but once the device is able to kind of really open and close then those symptoms alleviate themselves.
Host: Besides some of the things that you talked about, like a little bit of pain at the incision points, what are any other side effects that people might expect after this procedure?
Dr. Bolivar: It’s very uncommon that it doesn’t work for their reflux. I guess that’s probably the most common thing that people are worried about but lots of studies have shown that there are well over 90%, even higher than 95% that after five years of this procedure, people are still off their medication and not having reflux. Sometimes people can have some difficulty swallowing after the procedure and we need to give them some medications to try to help things relax a little bit and rarely do other procedures need to be done from this. There’s complications I guess directly related to any type of surgical procedure of bleeding, infection, risks of anesthesia, those are extremely unlikely with this procedure.
Host: Well it sounds like this, the LINX procedure, is really tried and true and you said that over – did you say a 98% success rate?
Dr. Bolivar: Greater than 95%.
Host: That’s pretty good, so it’s really great to know that this treatment option is out there for patients who have tried everything and their reflux won’t go away, this 95% success rate is pretty amazing in medicine. So Dr. Bolivar I want to thank you so much for educating us on the benefits of the LINX procedure. For a referral to a board certified physician, please call the Sierra Vista Regional Medical Center and Twin Cities Community Hospital Physician Referral Line at 866-966-3680. My guest today has been Dr. David Bolivar. I’m Prakash Chandran, thank you so much for listening.
Prakash Chandran (Host): Gastroesophageal reflux disease, otherwise known as GERD, can be extremely uncomfortable and disruptive in one’s daily life. Luckily a procedure called LINX is an effective way for reflux patients to get their lives back. Here with us to discuss is Dr. David Bolivar, a general surgeon at Twin Cities Community Hospital. It’s a pleasure to have you here today Dr. Bolivar. So I want to start with the basics because this may be foreign to a lot of people, including myself, but what exactly is gastroesophageal reflux?
Dr. David Bolivar (Guest): Gastroesophageal reflux, otherwise known as GERD, happens when stomach acid flows back from the stomach into the esophagus, and many people call this heartburn or reflux or just feel this uncomfortable feeling coming back into their chest or up even to the back of their mouth. So unfortunately this is a very common thing that happens to many people.
Host: So this is – it’s good that you make that clarification because you’re saying that the general acid reflux or heartburn that people experience on a day to day basis or when I have too much ice cream for example, that is an example of gastroesophageal reflux?
Dr. Bolivar: Yes, that is correct.
Host: Okay, so in the past I think people have tried to heal themselves by maybe taking some Tums and potentially if it gets really bad, going to see their doctor. Can you talk a little bit about what has been tried in the past and what has worked to help combat this?
Dr. Bolivar: Absolutely. So whenever anyone has gastroesophageal reflux, we always try to start with the minimally invasive manner, so lifestyle modification is what works the best. Eating smaller, more frequent meals, avoiding inciting foods, sometimes losing weight if someone’s overweight can be helpful. If that doesn’t work then adding medication, like you mentioned with Tums or the classification of stronger antacid medication can be sometimes helpful. Sometimes for all sorts of different reasons, that doesn’t work. People have their reflux symptoms of the heartburn go away but still fluid is still coming up into the back of their throat or going down into their lung and they really look for different alternatives, and that’s when we kind of fall into the surgical aspects of it.
Host: So let’s talk a little bit more about the surgical aspects of it. What are some surgical ways or procedures that you use in today’s medicine to help combat this reflux?
Dr. Bolivar: So for decades the traditional operation was called a Nissen fundoplication, which as an operation that if somebody has the hiatal hernia that we would fix that, bringing the hiatal hernia, if the stomach was up in the chest, we kind of bring it down into the abdomen, and then also wrap the stomach around itself and around the esophagus, so it would create in essence a one way valve. So things went down but they didn’t go back up. So this operation has been around for a long time, and it works really well with preventing gastroesophageal reflux. One of the downsides of it is that it’s a bigger operation and then also it’s not a great operation for things to be able to go back up if it needs to. So if someone ate too much or feels bloated or feels like they need to throw up, sometimes it can be difficult with that operation, called a Nissen fundoplication. So that would kind of segway us over to a newer procedure. It’s been around for actually quite a while in the world, but in 2012, the FDA approved this procedure called the LINX and the LINX is a procedure that laparoscopically, meaning through small little port sites, under anesthesia, we put a magnetic ring around the esophagus that has some flexibility. So if people ate, it is able to open up and allow food to go down, but then also keeps food from coming up. The really kind of exciting and cool thing about the LINX is that it’s a little bit more – it makes people back into their normal state. In that if you ate too much or you feel like you’re sick to your stomach, it does allow you to be able to vent the stomach, either be able to burp or throw up if you really need to. So that’s what the exciting thing is about it.
Host: That does sound really exciting and if I can just try to break it down in laymen’s terms, I’ll do my best here, it seems like that acid reflux happens when the acid from the intestine goes back up the tube when it’s not supposed to, right? So what the LINX is, I was just looking at some pictures online, it almost looks like a little bracelet, right? That goes over and restricts the ability for the acid to go back up, and it is – how does it expand and contract? Like what is it? Is it flexible? Is it a magnet? How does that work?
Dr. Bolivar: Yeah exactly, so it’s like a little bracelet, and it’s a titanium ring, but each of these titanium beads are held together. There’s small magnets in them, and with that, the magnets bring it back together at a resting state, but then when you eat you’re able to break that magnetic hold and then that’s what allows it to relax and open up and then go back down to it, kind of closed state when you’re not eating.
Host: The advancements are truly amazing, and like you said, unlike the original procedure that you were used to doing for so many centuries, this actually contracts when you do need to, for example, throw up or kind of get something back down. So it seems like it restricts at the right time and it also un-restricts itself when you need it. Would you say that’s accurate?
Dr. Bolivar: Yes that is correct.
Host: So I want to get into the proper candidate for the LINX treatment. Is the LINX treatment or procedure good for everyone? Who’s the best candidate for this?
Dr. Bolivar: So the best candidate is someone that traditional – the best candidate is the one that traditional methods for relieving their acid reflux has actually worked. So if someone takes medications and it works, but they want to get off the medication, they’ve tried lifestyle modifications, they’ve lost weight, and they’re just sick of having reflux, they’re not wanting to take medications anymore and just not having to worry about this, those are the ideal candidates. There are many other candidates for this, people that have secondary problems because of reflux. Sometimes people can have bleeding or severe irritation of their esophagus or it causing strictures or narrowing or a lot of other secondary problems, and those are candidates also. Before anybody would be able to have any type of operation, there is some preoperative testing that needs to be done to make sure that the operation itself will actually help and not make another condition worse.
Host: So is this considered a minimally invasive procedure?
Dr. Bolivar: It is. This is definitely a minimally invasive procedure. Even though it’s in the operating room done laparoscopically through small little incisions that are less than an inch in size, and most people are able to go home the same day as their operation.
Host: Yeah, that was the next question that I was going to ask you, what the recovery time was like. So even though they’re able to go home the same day as their operation, what are they feeling afterwards? How long does it really take to kick in and start working?
Dr. Bolivar: There’s a few phases of recovery after this procedure. Initially you’re just sore because of the operation you just had. So for about four to seven days you feel your incision sites and they kind of hurt. That slowly kind of goes away and you start feeling better. With the LINX procedure, you have this magnetic ring around your esophagus and you start to form some scar tissue around it. So the essence of it is people need to get on an eating regimen of eating small meals every few hours to make sure that your esophagus is opening up and closing and the LINX is opening up and closing. It’s almost like physical therapy for your esophagus and the thing that you want to do is to make sure it’s opening and closing so that long term it doesn’t get stuck closed. So that’s the biggest thing that we talk about with patients about keeping this moving early on.
Host: And what does that look like, keeping it moving early on? It seems like this is something that’s been approved, it’s been around for long enough, but how do patients when they’re recovering make sure that it’s actually opening up the way that it’s supposed to?
Dr. Bolivar: It’s by eating small meals somewhat frequently throughout the day, every two to three hours or so and the act of swallowing and having food going down through the esophagus opens that up. You don’t feel the LINX opening or closing. Early on after surgery, sometimes people can have that feeling like food is getting stuck a little bit, but after swallowing once or twice, that goes through, but once the device is able to kind of really open and close then those symptoms alleviate themselves.
Host: Besides some of the things that you talked about, like a little bit of pain at the incision points, what are any other side effects that people might expect after this procedure?
Dr. Bolivar: It’s very uncommon that it doesn’t work for their reflux. I guess that’s probably the most common thing that people are worried about but lots of studies have shown that there are well over 90%, even higher than 95% that after five years of this procedure, people are still off their medication and not having reflux. Sometimes people can have some difficulty swallowing after the procedure and we need to give them some medications to try to help things relax a little bit and rarely do other procedures need to be done from this. There’s complications I guess directly related to any type of surgical procedure of bleeding, infection, risks of anesthesia, those are extremely unlikely with this procedure.
Host: Well it sounds like this, the LINX procedure, is really tried and true and you said that over – did you say a 98% success rate?
Dr. Bolivar: Greater than 95%.
Host: That’s pretty good, so it’s really great to know that this treatment option is out there for patients who have tried everything and their reflux won’t go away, this 95% success rate is pretty amazing in medicine. So Dr. Bolivar I want to thank you so much for educating us on the benefits of the LINX procedure. For a referral to a board certified physician, please call the Sierra Vista Regional Medical Center and Twin Cities Community Hospital Physician Referral Line at 866-966-3680. My guest today has been Dr. David Bolivar. I’m Prakash Chandran, thank you so much for listening.