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Magnetic ring (Linx, Torax®)

Basics

Reflux and Heartburn occur as a consequence of the failed function of the Anti reflux mechanism in the lower portion of the esophagus (the lower esophageal sphincter; LES). The laparoscopic Magnetic ring operation restores the function of the lower esophageal sphincter.

Indications

Indications for the Magnetic ring operation include Heartburn, Reflux, sphincter damage restricted to the abdominal portion of the lower esophagus and a small hernia (< 3.0 cm). Reflux symptoms should at least partially respond to medical treatment (antacids, H2 blockers, proton pump inhibitor).

Preparation & management

Preparation and management are identical, as described for the Fundoplication. Gastroscopy, Esophageal manometry and esophageal Reflux monitoring are mandatory for the Magnetic ring operation. In contrast to the Fundoplication, we conduct the Magnetic ring operation as a day care procedure.
The experienced members of our team perform the Magnetic ring operation ( Anti reflux surgery) in our cooperating hospitals.

Magnetic ring (LinX, Torax®): how it works

Here we inform you about the fascinating working principle of the magnetic ring, the surgical steps and the excellent outcome after the operation. We also outline the advantages of the ring operation over laparoscopic Fundoplication.

Principle

The operation augments the Anti reflux mechanism (lower esophageal sphincter) by placing a magnetic ring around the lower end of the esophagus. The ring consists of magnetized titanium beads. At rest the magnetic attraction closes the ring around the esophagus and prevents Reflux. During eating the swallow induced forces open the ring and allow the passage of food. Thus the magnetic ring works as magnetic sphincter. In addition, the ring generates a magnetic field, which is known to inhibit inflammation and pain (anti-inflammatory effect of the magnetic field).

Operation steps

Using a minimal dissection the surgeon frees the lower portion of the esophagus. Thereafter the measuring device is bended around the esophagus to assess the outer circumference of the esophagus. This measure gives the size of the magnetic ring. The ring is placed around the lower end of the esophagus and closed. Now the novel magnetic sphincter starts to work and stops your Reflux. One to 2 laparoscopic sutures are applied to repair a small Hiatal hernia (< 3.0 cm). The entire procedure takes 20 min to 30 min.

Magnetic Ring

Magnetic ring operation. During the Anti reflux surgery the magnetic ring is positioned around the lower end of the esophagus. The attraction of the magnetic beads closes the ring around the esophagus and prevents Reflux. During eating the ring opens for the passage of the food.

Prognosis

the magnetic ring offers normalization of esophageal Acid exposure and Heartburn relief without medical treatment in 85% to 90% of the patients after 3 years.

Advantage over fundoplication

the advantages include a shorter operation time (20 min - 30 min vs. 60 min to 90 min), minor and shorter swallowing difficulties. So far slipping and migration of the ring have not be observed after more than 200 cases worldwide. If necessary (wish of the patient, necessity for MRT scan), the ring can be easily removed any time by a laparoscopic operation.

Disadvantage

performance of a magnetic resonance tomography (MRT) is not allowed, since it destroys the magnetic function of the ring.

Alternative test

computed tomography. MRT is mainly used for examination of disorders of spine, joints and soft tissue. In the large majority computed tomography gives adequate information and there is no need for MRT.

Eating behavior after magnetic ring operation


For the first 10 days after the operation you are recommended to be on liquid and crème diet. After day 10 you start to eat solid food. Minor swallowing difficulties may exists for 2-3 weeks after the operation and vanish thereafter.

Expert opinion

Sebastian Schoppmann (Surgeon, Vienna):

The Magnetic ring operation is a fascinating therapy for persons with Heartburn and minor impairment of the Anti reflux mechanism. Gastroscopy shows Hiatal hernia if less than 3 cm. For these patients classical Fundoplication is over treatment. The operation time is short and so far slipping has not been observed.

Martin Riegler (Surgeon, Vienna):

With our diagnostic tests we can identify those who will benefit from the ring operation. Candidates for the Magnetic ring operation are patients with Reflux symptoms and a dilated distal esophagus restricted to the abdominal portion of the esophagus.

Literature

  1. Becher A, Dent J. Systematic review: ageing and gastro-oesophageal Reflux disease symptoms, esophageal function and Reflux oesophagitis. Aliment Pharmacol Ther 2011; 33(4): 442-54.
  2. Bonavina L, DeMeester T, Fockens P et al. Laparoscopic sphincter augmentation device eliminates Reflux symptoms and normalizes esophageal Acid exposure. Ann Surg 2010; 252(5): 857-862.
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Tel.: +43 (0)1 / 33 66 565
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Daniela Kix