Nissan Fundoplication vs other proceedures?

I have had GERD for about 20 years. I am F, 58 years old and am about 40 lbs overweight. My GERD symptoms include heartburn, a cough, sore thoat, that thick feeling in the back of the throat that you can't clear, acid when I bend over, those episodes of mini "throw up", and during the last year, severe nasal and sinus congestion. I have had several endoscopies that confirm my acid reflux. Am Pre-Barretts and have a small hiatal hernia.

 

My surgeon is strongly suggesting that I have the Lap. full Nissan Fundoplication.

 

I am not so sure. I am going to try to lose some weight and he wants to see me in 3 months and do another endoscopy.

 

He assures me that the proceedure is quit improved and has good success.

 

 I do not like the idea of not being able to thow up. I wonder how often this proceedure has to be re-done; does it actually take care of Gerd for the rest of your life? How much gas does one have, if you cannot burp anymore?

 

I would like to hear from people who have had this proceedure or others for the treatment of Gerd. Good or Bad. I need help making a decision.

 

Thanks in advance to those who care.  Minnesota Grandma

 

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Thanks,

Kitt

Post Edited By Moderator (stkitt) : 3/4/2010 8:35:03 AM (GMT-7)

Hi Minnesota Grandma,
I had the laproscopic Nissen surgery about a year ago. My most severe symptom (aside from the heartburn/reflux issues and hernia) was uncontrolled asthma. The reflux was causing constant lung irritation. I was using far too much medication and steroids to keep me breathing. My doctors encouraged me to have the surgery, because it was a life-threatening situation. It took me four years to finally make the decision to go forward.

The surgery has been a godsend for me. My lungs are greatly improved. I do have concern that I may need a redo due to my heavy pre-surgery steroid usage which created very fragile internal tissue. This made it difficult for the surgeon to secure the hernia. The surgery made my health so much better that I wouldn't hesitate to redo it if necessary.

Not everyone who has the surgery has permanent bloating and gas issues. I may have a little more gas, but I am able to burp, which allows gas to escape. My burps are generally spontaneous. I'm not able to burp at will. I have anti nausea medications on hand always, in case I get sick. I actually had a stomach bug about a month ago, and found out I could throw up. My doctor did a loose wrap. I have had virtually no difficulty with swallowing (once past the early stages of recovery).

From what I've heard/read, the Nissen Fundloplication is the "gold standard" for repair of non-functioning LES/hernia repair. Other procedures are sometimes preferable for certain individuals, though. One of the tests you would get pre-surgery determines the strength and effectiveness of your swallowing reflex. People with less strong swallowing abilities may have a partial wrap, which will ensure less pressure is needed to get food through the wrap and into the stomach.

The recovery from the laproscopic procedure was a very pleasant surprise. I was expecting a much more difficult recovery. Every surgeon is different, but mine only had me on liquids in the hospital, sent me home the next day on soft foods, and after 5 days, after I'd seen him, told me I could eat anything that could be chewed to a liquid.

If you're ever interested, I could provide you with links that chronicle my recovery for probably the first 19 days. I am 57, so our ages are very similar.

I did a lot of research before having the surgery, and found the most important thing with this surgery is to have it done from an eminently qualified surgeon who had done many of the Nissen Fundoplication surgeries. Many excellent surgeons do not have enough experience in this specific surgery, and the outcomes can be very problematic. The success of your surgery will be dependent upon your surgeon's skill.

The surgery's longevity is variable, dependent upon the individual. I've heard of them lasting at least 20 years, others needing to be redone in a year, and everything in between. This forum was a godsend for me when I was trying to make the decision to have the surgery. I join them in feeling that although the surgery is far from perfect, it is worth the inconveniences to be relieved of the problems that the reflux has caused in my life.

Good luck in making your decision, and finding answers to your problems.
Take care,
Denise

Minnesota Grandma,
Posts by individuals like Looking Good Feeling Bad are the ones that made me wait 4 years, and allow my lungs to grow progressively worse, until high doses of steroids created adrenal insufficiency. While I'm very sorry that Looking Good is having so many difficulties, and I don't doubt them, I would like to emphasize that those problems are not the usual outcome. You might think so if you look online, because you'll find many dissatisfied, damaged post surgical posters. Keep in mind that most people who have successful outcomes don't bother to get online and search out others who are having problems. The internet posts are skewed in the direction of poor outcomes.

I agree with Looking Good in the recommendation that you don't make this decision lightly. You MUST research surgeons in your area and fine out which one has a track record of good outcomes and lots of experience doing the procedure. You will not be restored to your youthful, pre-GERD condition. This surgery does create some GI inconveniences, and it takes a good year to be completely healed. Most of the healing takes place in the first couple of months, however.

This is a decision to be made by you, with the consultation of your doctors. It's not an easy one to make. You need to know that there are risks in any surgery. You can minimize those risks by researching and knowing what you're doing if you go forward.

There are many very happy post surgical patients.
Don't let those people with poor outcomes keep you from going forward if it's the right thing for YOU.
We're here to offer support and advice.
Denise

Looking Good...so sorry you're suffering. I hope you find a way to improve the results you've experienced. Hang in there. There's lots of support and encouragement for you here as well.
Take care,
Denise

In response to the negative posts:

 

I do realize that there are probably more negative posts regarding bad outcomes from Nissan surgery than there are good ones. And I agree, that is probably because the good outcomes seldom have cause to make a post and have no need to complain.

 

I appreciate hearing about the bad outcomes as well as the good ones.

 

Believe me, I do sympathize with those of you who have had bad experiences with your medical care.

 

I am a little gun shy because I have had some pretty poor outcomes with wrong diagnoses in the past, as well as being treated with absolutely no dignity. That is why I have become my own advocate and do not take the advice of one Dr as gospel.

 

It is a shame that it costs so much for our medical care. Otherwise, we could go from Dr to Dr until we found one that had their ducks in a row and truly cared about you.  Pray for smart reform of our health care system. What has taken years to break, cannot be fixed overnight.

 

Thanks again for everyone's thoughts.

 

Minnesota Grandma

 

 

I too was terrified of the surgery. I had only heard of the bad things. Even my GI gave me horror stories.
I came here and heard all of the stories and it helped me in my decision to go forward an do the surgery.
I searched for a long time for my surgeon. I called their offices and talked with the nurse. If a nurse has a high opinion of the doctor I'd visit him and talk. I had one nurse who trusted her child to have the surgery with the doctor she worked with. She had high praises for him, so this helped me in making my decision.
I'm glad I chose my own surgeon, instead of going with the surgeon my GI wanted.

Joy

Bill, there's an old saying "the squeaky wheel always gets the oil". I believe that has happened with the news on the surgery. Unhappy people will complain the most and the loudest. That's why you hear more bad news than good.
If you look at the 6 o'clock News that is a perfect example.

Joy

Hello Minnesota Grandma

I hope that you can find a good surgeon to do you surgery for you and I wish you the best. It sounds like surgery is effective for most people, but some don't have positive outcomes. myself I would rather live with the side affects from the surgery than with GERD.

I have had GERD for about 13 months. I don't get heartburn at all. My symptons are stomach pain. I feel like someone has punched me in the stomach right above my navel. I also have a heavy, full feeling in my stomach. I asked the doctor why my pain is by my navel when my LES is located much higher. She told me that it is referred pain.

Speaking of horror stories about GERD, there is a lot on the net about people who have the awful disease. When I developed GERD last winter, I read stories after stories of people having GERD on the internet that just horrified me. I developed severe anxiety because I realized that all of a sudden my quality of life is gone and that I will never be the same again. In a foolish move after not being able to sleep because of GERD, I quit my job. I couldn't handle the stress the job demanded having GERD. Now I am in Omaha. I got married this past July and moved to where my wife lived. I just found a job that pays half of what I used to make.

I am from Minnesota as well, near Alexandria. What area are you from Minnesota Grandma? I miss Minnesota and my wife & I hope to be able to move to MN next year.

Good luck! I wish you the best. Hopefully you can find a great surgeon and it is successful.

Steve

 

Hi there! I did have the Nissen almost 7 weeks ago. I found the initial diet after surgery difficult. That may be because I was completely unprepared for it. I have not had any need to vomit, but my surgeon told me it shouldn't be a problem. I was able to burp soon after. At this point, I'm able to eat most things. I would not go into this lightly, but if you really need it - it could be a good option.
Best of luck!
Stacey

Minnesota Grandma,
My surgeon was experienced in working with obese patients and was comfortable with doing my surgery without me losing weight. I've lost weight since the surgery (20 lbs) and am hoping it continues to go.

Joy

 Denise:

Definately keep the good attitude. That will take you a long way. It is a frustrating process......I can testify to that. Gerd is only one of my multiple problems. I am one of those "unfortunate" souls who has all of those things that are "not textbook" and finding doctors who will take time and "think outside of the box" has been a real exhausting ordeal.  I feel like sending roses and a big thank you to the handful of Dr's who have gone the extra mile for me...............My prayers and best wishes to all.!!!!!!!!!!!

I just met a gal who had the full wrap at about age 27. 18 months later, she had kidney stones and severe vomiting. It is now 10 years later and she is sure her illness after the surgery "undid" some of her wrap. She has been searching for someone to re-do her wrap, but is having uerology (sp) problems and has to be cleared in this area before her surgeon will "touch" her.

My gut says the surgeon is giving her the brush off. I am going to look into the surgical center that one of the posts suggested in Crosby, MN. Peaked earlier and it looks like the surgeons are well qualified. I will definately post comments if I talk to them. I have to find out if they are in my insurance's network..............

Minnesota Grandma

 

I must say that I agree with your last statement.....the fundoplication must fit the patient, not the other way around.....one of the reasons I put on the brakes and am doing research. Interesting to hear about the mesh. My surgeon said he uses it in addition to stitches. Makes sense when you think about the mesh, where it would be located in proximatey to the esophagus and the possibility of complications.   Thank you.

Minnesota Grandma