I was some minutes ago on the stretta forum and read something from one of the best reflux/lpr dr in the world: mark david noar.

I just copy/pasted it and marked the lines bold with regard to the lpr. In this post he talks about lpr after a linx but ofcourse you can also change the linx with a to a too much narrowed esophagus with a loehde 3d net.

I realy think this is the explanation why some unlucky people gets lpr after loehde when it is too heavy narrowed:

Sorry for the delay in answering.... There are two reasons why following a L INX device placement. There would be gas buildup and pressurization leading to LPR. One of them is potentially due to unrecognized gastroparesis or functional gastric outlet obstruction that was not treated in advance of the placement of the device, and the other is because the device by design is created to over tighten the lower esophageal orifice to prevent reflux. This creates a pressurized situation and the stomach because the normal LES will always allow small amount of escape pressure naturally, which is no longer as easy once the L INX device is in place. I have perform the Stretta procedure in patients who had the L INX device removed as well as left in place. Once the device is removed, reflux and LPR are controlled by the stretta procedure, assuming that they have returned after removal of the device. There is a small percentage of people who have the L INX device removed and because of scar tissue will not reflux again. The reason why the Stretta procedure does not create the same situation is that it works physiologically to strengthen the sphincter, which can still function normally. The difference is it just does not open as readily and therefore limits reflux. The reason to leave the L INX in place and to do the stretta is that the L INX is frozen in the open position causing free unchallenged reflux. The Stretta procedure then reinforces the intrinsic or internal sphincter of the LES which then closes down that opening. This is also the reason why you do not get the pressurization effect. When considering a patient who has the device in place, I do not suggest removal unless it is overly tight and is creating damage to the esophagus with pooling or difficulty swallowing, or that is just not effective but not frozen in the open position. Another reason to have it removed is if it's causing more symptoms such as pain or discomfort. In your particular case, the decision to remove the device would be that you are getting worse, as it appears that you are. In any case, I would consider removing the device and then waiting to see if your reflux comes back the LPR does not self-correct. If the reflux does come back and the LPR does not self-correct within the Stretta procedure would be appropriate. The matter what you will still need your gastric motility evaluated before any change takes place. In fact, it would be important for you to find out if you have gastroparesis or functional outlet obstruction which requires an electrogastrogram. If you do, is possible by correcting this problem you may get better without any change.

Personally after the loehde I also noticed that I get much easier as before gas burps and some days I have lite lpr complaints. Luckily most days not and I feel completely fine but I must really watch that I don't get too much gas build
in my stomach

Hey Maarten thanks for this great info.....I had the Loehde operation in 2019, after the operation I had 8 mounths cramps in my stomach and I was bloaded very much. My gastro doc thought it comes from irritation of the vagus nerv after the operation wich can happen easyly in this kind of operation, but it should be ok after a jear. So it needed some time but after 12 mounth i felt quiet good. This jear in April a got a hernia again (just a small one but enough) and now I have massive lpr. Last week I did a test in the hospital and it looks like that my stomach is emptying very slow.....so it looks like a gastroparesis (i think the vagus nerv didn´t "calm down" completle after a jear" ) perhaps the over tightend lower esophagus hold some gas back and now with the hernia it come easier up (just a theory) ....

So if i understood this theory of mark david Noar right than I have to do something against the gastroparesis and my symptomes can get less?? I thought about this theory, too.......I will write my complete "operation storry" in the loede rubric when I find some time but thanks for posting this!

Hi Silet mike. Yes I think you are correct. LPR should be approached from an holistic point a view. I have an academic degree and mark david noar taught me really a lot. It all comes down towards if your les can overpower the gastric yield pressure. You can accomplish this with getting a higher les resting pressure (wrapping your stomach around the les, narrowing the les with loehde net, doing the linx etc) but you also work with preventing to much gas build in your stomach. With a lwo stomach emptying you have the chance that your gas build will be too high because the fermentation of the food stays too long in your stomach. When the pressure is too high the les will open with gas burps. Work towards getting a better and faster digesting process. Some tips are: use digesting enzymes after your meal and mark david noar also recommends to do procedure to dilate the pyloric sphincter somewhat so that the food travels faster towards the intenstines (this is an easy procedure and with great result). Take care

Take a hydrogen-methane test for SIBO (prepare properly), if it's positive -> cure sibo (not easy) or learn to control its symptoms (diet) and then see how you feel. Fermentation does not take place in the stomach, people after years of using PPIs have broken intestines and this is the cause of all the strange relapses after surgery (and often even before). It's all the fault of bacterial growths that are in the wrong place. I'm not a doctor, these are all my thoughts based on observing people's reports. I rarely come here.