A 3-cm cutoff was used for hiatal hernias in the trial and is recommended for early adoption in the community. A study is planned looking at hernias greater than 3 cm with no upper limit, where the minimal dissection method cannot reduce the hernia and full dissection is required, and the only requirement is that the patient have normal esophageal motility, he said.
Discussant Dr. Douglas Smink from Brigham and Women’s Hospital in Boston, said, “[There is a] lot of interest in this procedure obviously and it’s really nice to see what it’s like outside of the trials and to see your data is very similar.”
He went on to ask whether Dr. Buckley is still recommending fundoplication and, if so, in whom.
The LINX device has supplanted a classic Nissen fundoplication as the first-line operation in patients with good esophageal motility, although the device is not entirely covered by insurance, Dr. Buckley said.
“Basically, I tell patients I think it’s a marginally better operation. It’s not leaps and bounds, but it’s a marginally better operation,” he said, adding that though there has been concern about erosions, their erosion rate is zero and thus far, only seven erosions out of nearly 4,000 devices placed.