New London ― Prior to December, Brian Bates would wake up 10 times a night from acid reflux, sometimes not breathing and turning blue:

“The esophagus is spasming, so it’s clenched up and you can’t get anything up or down, and you cough until the point you throw up,” he said.

Bates, 60, couldn’t eat within a few hours of going to bed, so he and his wife would head out for dinner around 4:30 p.m. and friends would make plans early to accommodate him.

But no more.

On Dec. 15, the Waterford resident underwent a minimally invasive surgery at Lawrence + Memorial Hospital that added the LINX Reflux Management System, a device that gets placed loosely around the lower end of the esophagus to treat gastroesophageal reflux disease (GERD).

“Not to make it so grandiose, but it was life-changing to have the procedure done, just from what had become the norm, which was miserable,” Bates said.

He added later, “It’s been a very nice change, waking up not feeling miserable with so much clamped up in your throat that you feel like you just smoked 10 cigars.”

Dr. Jonathan Blancaflor began performing the procedure at L+M in December and is currently the only surgeon offering it in the Yale New Haven Health system. He said in six months, a regulatory body will look at results ― “which have been excellent to date” ― and determine whether to expand the procedure systemwide and to other surgeons.

In an interview with Bates in an L+M waiting room Friday, Blancaflor held out the LINX device: a stretchy band a little larger than a ring, containing 11 magnetic beads.

He explained that when food passes through the esophagus, the organ expands “much like a snake does when it eats a mouse” and pushes on the beads, which stretch but then close because of the magnetic force.

Blancaflor said the surgery cures 98% of recipients of regurgitation, and the explant rate ― meaning the device has to be removed later for some reason ― is less than 1%.

An alternative and precursor to the LINX system for treating GERD is a Nissen fundoplication, a surgery Dr. Rudolph Nissen developed in the 1950s that is now routinely performed laparoscopically, meaning with small incisions and the aid of a camera.

The surgery involves wrapping the upper part of the stomach around the lower part of the esophagus and stitching them together. This reduces reflux by increasing pressure on the lower esophageal sphincter.

“It’s a very good procedure in the right hands for the right patient, if it’s properly done,” Blancaflor said, but even then, it will only work for 10 or 15 years.

As an experienced surgeon, Blancaflor was able to get training on the LINX procedure when it came out; he was at Middlesex Hospital at the time.

He left in 2017 to go to Utica, where he started a robotic surgery program, before coming to L+M. Blancaflor estimates he did about 25 LINX procedures in Utica and has done 50 in total.

Bates said when Blancaflor told him about the LINX procedure, that was his choice, as he didn’t want another surgery in 10 or 15 years. And he was persistent: His surgery was rescheduled five times because of the L+M’s regulatory processes.

As 2023 loomed, he considered going the route of the Nissen fundoplication, as he had hit his insurance deductible and wanted to get in the surgery before the end of the year. But Bates, whose job is supervising table games at Mohegan Sun, described himself as a patient man, having raised five daughters and one son.

Bates said he was also prompted to take action because of the fear of constant GERD leading to esophageal cancer. Blancaflor explained that medication can decrease acid coming in but doesn’t stop the reflux itself, meaning there is still risk of esophageal cells becoming cancerous.

From scope to surgery

Bates said he has suffered from acid reflux since he was probably 15. He isn’t sure exactly what caused and exacerbated it over the years, commenting, “I live a pretty decadent life. I drink, I smoke, I eat whatever I want, with the exception of anchovies. I’m going to live ‘til I die.”

He had gone from taking 20 milligrams to 40 milligrams of omeprazole, a drug used to decrease excess stomach acid and treat heartburn, but he called it “going from a Band-Aid to gauze. I’m not fixing anything.”

His wife had a hiatal hernia repaired in 2021, and when Bates described his own symptoms, the doctor said it sounded like he had a hiatal hernia. This was confirmed through an endoscopy he scheduled with a colonoscopy in the fall of that year, and the gastrointestinal doctor immediately upped his omeprazole to 80 milligrams.

He was also referred to Blancaflor, and since the surgery, Bates doesn’t have to take omeprazole or any medication resulting from the procedure. Bates wasn’t worried about getting the hernia repair and LINX procedure in December, considering he has had several other surgeries before.

The surgery was done through little incisions in his abdomen, and Bates didn’t struggle with pain afterward. Blancaflor said LINX is primarily an outpatient procedure and can be done in as little as an hour, but Bates’ hiatal hernia was big so he was kept overnight.

Blancaflor explained that most people with reflux have a hernia and most people with a hernia have reflux, but health care professionals “need to test patients rigorously to make sure the symptoms they’re having is reflux, and the esophagus is strong enough to actually push food through.”

Bates said everything about the surgery and recovery went exactly as he planned.

“My recovery, everything, the sleeping an hour to an hour and half more a night, I can’t ask for better results. I can’t,” he said. “I was telling Dr. Blancaflor earlier, I don’t think, since the surgery December 15th, I’ve burped 100 times.”