Compliications from nissen fundoplication

I need some advice for my mother. She is 79 years old and had laparascopic nissen fundoplication on Nov 16. During the procedure her liver was torn by the retracter and her lung collapsed. The procedure was done in Urbana, IL and because of her complications was transferred to Barnes-Jewish in St Louis where she was in ICU for 8 days. She is now 5 1/2 weeks out of the surgery but is still suffering from nausea and lack of appetite. She is in a continual loop of being sent home from the hospital only to be readmitted a few days later from nausea, dizziness, and dehydration. Because of the liver tear she has two drains that have not yet been removed. Hopefully they will come out on Jan 2. They could be out now but the only doctor who could do it is on vacation for the holidays. Her stay at Barnes was good especially since they saved her life but after this experience I have no confidence in her local physicians/surgeon. Before she was transferred to Barnes, her surgeon thought her wrap was too tight because they were unable to pass an endoscope when they were doing a procedure to treat the liver tear. While at Barnes the doctors felt the wrap was fine. Now she is back in the hospital and her surgeon is leaning towards loosening the wrap. I'm hesitant because I'm not sure she has had adequate time to determine if it is too tight. For the most part she has no appetite because of the nausea but when she has been able to eat she doesn't seem to have trouble swallowing. The surgeon plans to do another swallow test before deciding whether to loosen the wrap. I asked him how many times he has had to redo one before and he said only a couple of times since his wraps are usually good. That in itself worries me - he did the wrap too tight and caused major complications. I'm not sure he had enough experience the first time he did the surgery so I'm scared to give him a second chance. I also don't think he is considering the fact that she is still recovering from the complications and wants to jump into a procedure she isn't physically ready for. Am I worrying too much? If not, how do I find another surgeon preferably in central Illinoiis for a second opinion?

Post Edited (franciss) : 1/1/2013 5:39:08 PM (GMT-7)

franciss

So sorry to hear of your mother's ordeal. I can recommend Dr. Fisichella at Loyola Medical Center near Brookfield Zoo. He is very good and they were top notch in figuring out what was wrong with my first nissen. The staff was great during my 3 plus week stay there. Send me an email and I can give you his contact info.

Take care,
Bill

Hi franciss,

The thing is that if her stomach is acting up, the reduction of acid could help its condition.  Actually many post-Nissen patients are kept on PPIs during the recovery phase.  It takes 6 months for most of the healing, and a full year for the rest.  While it would be lovely if she could stop the medication, if her doctor feels it will help her condition, I'd be hesitant to suggest that she stop it.

Since she's had complications, it's even trickier, and will make the recovery longer and probably more difficult.  It takes some healing for the swelling in the wrap to subside, and while swollen it can allow more reflux than it will once it's established and fully healed.

The PPI can also protect the healing wrap from acid.  It's not at all unusual for surgeons to recommend continued use of PPIs.  If her wrap is working well once she's healed, and the doctors don't think it is necessary any more, then you can always try stopping it. 

One thing you need to realize.  A Nissen fundoplication surgery does not take reflux to zero.  If the wrap was tight enough to accomplish that, your mom wouldn't be able to eat.  It just brings it down to "normal" levels--so it's like the reflux experienced by non-GERD sufferers.

Therefore, if your mom has a slow-emptying stomach, there is a longer time when reflux can escape.  Until she's fully healed, it makes sense.  If you have concerns about her continued use of PPIs I suggest you discuss it with her GI doctor/surgeon to help you understand.  Be sure to voice your concerns and see how they respond.

I hope she gets feeling better soon! 

Good luck!

Denise

I'm glad your procedure went well at Carle. Unfortunately my mother had hers done at Provena. She was doing much better but had a set back a few days ago and is back in the hospital. She is now suffering from Cdiff and also had to have the biliary stint put back in yesterday. Apparently it was taken out too soon. The physician who put it in wasn't there when they took it out last week and wasn't pleased they had done it. Her condition is not good right now and we will be taking her back to Barnes probably on Monday. One of her GI doctors at Provena actually thinks the wrap should be undone completely and not redone. We don't agree so want to get the second opinion and hopefully better care at Barnes.