Well, after many months and discussions with various surgeons, my surgeons and I have made a decision regarding my surgical needs that I feel really good about
! This will be # 4 esophageal surgery and I expect my last. I am 67 and have seen over the nearly 30 years I have been "working with" my esophagus many great changes in treatments, both medicines and surgeries. I have had 3
open and complex Nissen Fundoplication surgeries in the past. All three included Hiatal Hernia repair. All were
open (no lap surgery perfected at the time). After all the usual and "unusual" tests, it appears all the previous wraps which are completely functionless and may be calcified and the LES is, of course, is
open and functionless.
The surgeons and I have been concerned as I am older that having a much needed NF would, if consistent with the past 3 become functionless over time requiring yet another major (
open) surgery in my advanced years (80+ years old). I no longer can function without surgery...the question is what can be done.
We have settled on some form of the following (the surgeons won't know all of what they will be doing until they are in the surgery (repair hernia, if possible remove scar tissue and previous calcified wraps, etc.). I will be having a Gastric Antrectomy with Roux-en-y Anastomosis rather than the NF. The Roux-en-y part will Not be for weight loss/bariatric but to be able to bring the secretions from the lower stomach into the bowel with the food/liquid. By doing this, the LES will be left alone but regurg/reflex will have a long way to travel before it can reach my esophagus. The reconstruction that we have decided on will eliminate the LES problem...and therefore a need for another repair. The Roux-en-y part of the surgery will leave me with the majority of my existing stomach. After healing, I will be able to eat normally (both kind of food and quantity.)
It is a really "big" surgery with a lengthy recovery, but the prognosis is excellent. The "burp, vomit" issue with some with the NF won't be a problem...I can do both now and that won't be altered. I will be able to eat normally and the surgeons expect that I will be not need to take esophageal or stomach medications after appropriate healing. They do not anticipate regurg or reflux.
The surgery is scheduled for April 20! I am excited about
this approach and feel really good about
proceeding. The docs expect hospitalization of 1 1/2 weeks with no complications. After the general anesthetic, I will have the pain managed with an epidural while hospitalized, as needed. Lots of cuts, lower part of stomach removed, new "faucets and hook-ups" but I now have hope for a normal quality of life, which I haven't had for the past few years. I won't know for months if I will get my voice back but I expect I will, with time. They expect the Chronic Bronchitis and asthma that have developed from my the inoperative LES and now almost constant wheezing to not be a problem after I heal from the surgery. They fully expect I'll be able to breathe normally and to sit, stand and bend without difficulty. Now, when I bend even an inch, I choke, can't breathe, and feel like my esophagus will burst. I am looking forward to the relief!!
Although this isn't the "typical" surgery discussed on this forum, I mention it, first because I have had 3
open NFs over many years, and 2nd, should anyone have difficulty with their LES after typical treatments/surgeries, there are encouraging solutions.
I have had good results this past two weeks with the Carafate (coats esophagus and stomach and helps with healing the esophagitis) Nothing has helped over the years...but this does, to some extent. I take the Carafate (1 gram) with Erythromycin (250 mg) which for some reason facilitates the motility in the esophagus and stomach helping with stomach emptying. This has worked also (again, nothing else has helped, over the years) which greatly reduces food regurg. My last Upper GI (Barium Swallow) showed my esophagus and stomach were filled with food about
15 hours after my last meal. It is nice to have that reduced!
Well, that's it for now. Looking forward to the 20th of April. Actually, a couple of months after that
Please weigh in on this...many of you have a great deal of knowledge and experience and I'll welcome your comments and info.