Robotic Removal of Linx Device with Conversion to Nissen Fundoplication

Jessica Weiss, MD; Angel Reyes, MD, FACS

Product Details
Product ID: ACS-5852
Year Produced: 2019
Length: 8 min.


This video presents the robotic-assisted removal of a disrupted LINX device and conversion to Nissen fundoplication. The patient is a 71-year-old male who presented to the emergency department with epigastric and chest pain two years after placement of LINX device for gastroesophageal reflux. Chest x-ray demonstrated a posterior disruption of the LINX device. The patient reported recurrent reflux symptoms and was interested in surgical intervention. Preoperative workup included esophagogastroduodenoscopy to rule out erosion of the LINX device and esophageal manometry. Significant manometry findings included a distal contractile integral greater than 1000 and a normal integrated relaxation pressure. It was recommended that this patient undergo removal of the LINX device with conversion to Nissen fundoplication for reflux management. In this video we highlight the key steps of LINX device removal and preparation to perform a tension-free wrap including division of the LINX capsule with complete device removal, dissection of the hiatus with complete removal of both the anterior and posterior LINX capsule, and complete mobilization of esophagus with reduction into abdomen.