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Behind the knife, the surgery podcast. Relevant and engaging content designed to help you dominate the day.

Everyone, great to be back with you all. I'm Dr. Mike Whitekamp, a surgery resident at the University of Washington. And I'm here with Dr. Andrew Wright and Nick Citruo, who we will recognize from our previous podcast on Robotic Surgery and the Management of Post-Engineal Courney Repair growing pain.

I'm also incredibly excited to introduce Dr. Nicole White, who is our Section Head of General Surgery at the University of Washington's Northwest Campus. Dr. White is a fellowship trained, minimally invasive surgeon, has performed more than 1400 robotic operations.

And like our other two co-hosts is a long time favorite amongst us residents and medical students at the University of Washington. Dr. White, it's great to have you here with us.

Thank you, Dr. Whitekamp. I want to say you're one of our favorites too.

Thank you. I appreciate that. We have a great show lined up for you all today, in which we're going to discuss the surgical management of gastroesophageal reflux disease and two of the approaches available to address this pathology in the operating room.

Namely, a fund application and magnetic sphincter augmentation, better known as the Lynx procedure.

Since this is a journal review episode, we'll be using two recent articles from surgical endoscopy to guide our discussion.

The articles are links, magnetic esophageal sphincter augmentation versus nisten fund application for gastroesophageal reflux disease, a systematic review and meta-analysis by Dr. Daniel Schoublening and colleagues from 2017.

And our other papers entitled three year clinical experience with magnetic sphincter augmentation and laparoscopic fund application by Dr. Luigi Bonavina and his colleagues published in 2020.

Before we dive into our papers, Dr. White, would you mind giving a quick overview of exactly what links is for our listeners who might not be familiar?

Of course. First, I want to give a quick review of the pathophysiology of reflux.

There are three main components. The phranosophageal ligament, which keeps the gastroesophageal junction intro-downally, the lower-sophageal sphincter, which is a area of high pressure zone, which keeps the pressure but is not truly an anatomic landmark, and the gastroesophageal valve, which is where the muscles converge of the oblique longitudinal and circular musculature and form a valve,

which is a one-way flat valve. It's important to remember this anatomy when you're talking about the different types of reflux issues.

So the links device is an implantable anti-gastroesophageal reflux system. It's comprised of a circular magnetic band with a variable number of titanium beads.

It's somewhat like a Roman arch, so that when the bolus goes through it expands uniformly and then closes uniformly.

This is placed laparoscopically around the G.E. junction in order to recreate the physiologic valve in reflux patients and thereby reduce or eliminate their symptoms.

Links was marketed as an alternative to fund application. While we're going to discuss the role of industry involvement in research and surgery in a bit,

it's important for us to note that while none of us have any financial conflicts of interest relevant to the device,

the University of Washington was involved in the original links trial that helped lead to FDA approval,

and Dr. Wright was involved in the Sages Technology Review of Magnetics Vincter Augmentation.

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