Tri-County Health Care in Wadena is one of only nine medical facilities in the state that offers the LINX Reflux Management procedure. One of the many minimally invasive procedures offered at Tri-County, LINX is considered a permanent fix for acid reflux. Dr. David Kloss is a board certified surgeon who has been specially trained to perform the procedure.

Dr. David Kloss, a board certified surgeon, has been specially trained to perform the LINX Reflux Management procedure. Kloss is holding the LINX Reflux Management system in his office at Tri-County Health Care in Wadena. Photo by Nancy Leasman

Dr. Kloss graduated from Pennsylvania State University College of Medicine in 1986. In his years as a general surgeon, Dr. Kloss has performed procedures to treat acid reflux or GERD (gastroesophageal reflux disease), but none have excited him like the LINX procedure.

“The other procedures we’ve used to treat acid reflux don’t work as well,” Dr. Kloss said as he showed what looked like a small bracelet of silver beads. “This is exciting to me because my patients are no longer in pain. They’re happy and that’s the essence of job satisfaction for me!”

Acid reflux occurs when the valve in the esophagus, where it enters the stomach, isn’t working properly. Since the valve doesn’t close completely, it allows stomach acid or stomach contents to back up into the esophagus. This causes burning pain, abdominal discomfort, and  in some cases, a persistent cough.

“Some people have had 30 years of pain and discomfort. They take a lot of pills and know that the pills may cause an increased risk of bone fracture from long-term use,” he said. “The most effective procedure we’ve used, up until the LINX procedure was developed, is the Nissen fundoplication.  With the Nissen procedure, we wrap the top of the stomach around the lower esophagus. This helps support the valve where it enters the stomach and makes it less likely that the acid will back up into the esophagus.”

While this surgical procedure offers relief, it isn’t considered 100 percent effective and has a longer recovery period. “Nissen requires a lot more surgery on the stomach than LINX, and this makes the Nissen surgery take a lot longer in the operating room. Some people have difficulty swallowing after the Nissen procedure; they may also be unable to belch or vomit. And the effectiveness fades after about five years,” he explained.

The LINX device is about the same size as a quarter. Contributed photo

These factors explain why biomedical engineers have continued to look for a more simple and effective solution. Having an engineering background, Dr. Kloss gets excited about new medical developments and devices, yet he didn’t jump right into doing the LINX procedure. “I waited about five years after the procedure was developed. There was solid data that the procedure was working with little risk and few sides effects. That’s when I jumped on.”

Dr. Kloss eagerly shows the small ring of beads that looks as much like a piece of jewelry as a miracle widget. The LINX device is a bracelet of magnetic beads that, when wrapped around the junction of the stomach and esophagus, is strong enough to keep the valve closed to refluxing acid but weak enough to allow food to pass through. Each bead is on a separate wire joined to the next bead which allows expansion and contraction. The ends are joined by a magnetic clasp, which securely holds it together. The ring is implanted during a minimally invasive laparoscopic procedure, which takes only about an hour and a half. It’s held in place by the abdominal anatomy as well as a small tunnel in the tissue surrounding the esophagus. While it allows for an ease of swallowing, it also expands if there’s a need for gas or food to move in the other direction.

Not everyone is a candidate for LINX. Dr. Kloss sits down and visits with each person, explains the procedure and answers questions. He also orders tests which reveal the source of the individual’s reflux. “We insert a thin, flexible tube to look at the lining of the esophagus to see if there is inflammation or other problems. We do an acid test to determine the amount of acid being produced. We do a swallowing test to measure the coordination and force exerted by the muscles of the esophagus. And we look for hiatal hernia, which is when there’s a tear or opening in the diaphragm where the esophagus goes through. The hole allows the stomach to push up through, causing pain.

“We go over everything. I show them pictures and movies of the procedure if they want. We just have a nice visit, and I think that makes a happy patient.”

Reflux is caused by a weak muscle in the esophagus called the lower esophageal sphincter that allows acid and bile to flow back from the stomach into the esophagus, possibly causing damage to the lining of the esophagus, throat and lungs. This is shown in the first two photos. The two photos on the right show the LINX device, with a small ring of magnets that opens to allow food and liquid down, then closes to prevent stomach contents from moving up. Contributed image

Eileen Broughton, of Verndale, required both a hernia repair and LINX procedure. “I had lots of acid reflux and regurgitation for years,” said the 62 year old woman who had her procedure the end of December 2018. “I couldn’t eat raw onions or garlic, and I was on a high dose of omeprazole (an acid blocker). Now, I’m off meds. I can eat normally and I’m really happy I had it done. I also like that it’s reversible. Dr. Kloss was very thorough, and I’m very happy with him.”

While Eileen’s experience with the LINX procedure has been a good one, she admits it took a while to get things rolling. “I called around, and most places don’t do it. Once I found Dr. Kloss, it took about a year for approval for the surgery.”

Dr. Kloss said that not all insurance companies are willing to pay for the procedure. “It’s new (available for about 10 years) and is more expensive than the Nissen surgery. There is a third-party appeal process if it is not covered. Our staff will work with patients and the insurance companies on that process.”

He knows that the results of the LINX procedure are better than the Nissen and that it’s worthwhile to go through the necessary process of approval. “I see it in my patients. When a patient came in after the Nissen, they would come in hunched over. I’ll see a guy a week after the LINX surgery, sitting up straight. They can eat anything and have no heartburn. And 100 percent of my patients are off their reflux pills. That’s what gets me excited.”t

The LINX surgery does not require an overnight stay in the hospital. Post-surgical therapy takes the form of eating small snacks every hour for eight weeks. “When you have a knee replacement you have to stretch the joint and muscles to regain full motion. With the LINX it’s important to regularly stretch the esophagus, through swallowing, to prevent formation of tight scar tissue,” Dr. Kloss explained.

When Dr. Kloss started doing the procedure two years ago, he anticipated working with a younger crowd of GERD sufferers. However he has helped people of all ages, from 20 to 82. I’ve done 8 people over the age of 70. I’ve had people in who can’t tie their shoes, lie flat or even walk their dogs without acid backing up.” The LINX procedure can change all that and affect health in positive ways beyond acid issues if it allows them to be more physically active and enjoy life.

Dr. David Kloss, Tri-County Health Care surgeon, gives a consultation to a patient about the benefits of a LINX procedure. Contributed photo

There are an estimated 40 million people across the nation who suffer from GERD. Research is revealing that overeating or binge eating may be a primary cause. When the stomach is repeatedly over-stretched it causes loss of elasticity of the valve. Biomedical engineers have looked into all aspects of the problem, and developing a device that works well is a thrilling achievement.

Tri-County Hospital primarily serves residents of Wadena, Todd and Ottertail counties. As the Tri-County website says, “Providing care for every member of your family at every stage of life, Tri-County Health Care family physicians believe in building relationships that will last a lifetime.”

Tri-County recruited Dr. Kloss to come to Minnesota from Connecticut to focus on minimally invasive procedures. He’s happy in Minnesota and likes that he can be available to anyone. “People don’t need a referral to see me. They can just call and make an appointment.” He also notes that the Deptartment of Veterans Affairs doesn’t offer the LINX procedure at the present time, but veterans may come to him.“They can have everything done here.”

For more information call the Wadena Clinic at 218-631-3510 or visit Tri-County’s website at www.tchc.org. To learn more about the LINX procedure and Dr. Kloss, click on the website link “What We Offer.” Under “Specialty Medicine,” click on “Minimally Invasive Surgery.” Look for Dr. Kloss and follow the “LINX procedure” link or simply go to www.tchc.org/linx.

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