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Partial Nissen Fundoplication Surgery in 4 days -- some questions/concerns

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Posted 4/23/2013 6:41 AM (GMT 0)
Hi all.

So let's start with some background. I have had heartburn for about 4 years now and more recently, have had some pretty severe regurgitation issues whenever I lie down. I was prompted to go to a GI doctor around Christmas when I had a really scary episode where I woke up in the middle of the night with a terrible burning sensation in my chest and back of my throat. No amount of water, milk, or acid reducers (tums, etc) would dull the pain; it took about 3 hours to go away on its own. I've since had 4 more similar episodes, and we have discovered that I am aspirating bile into my lungs which is causing the pain and why drinking/taking tums does not help.

I have had an endoscopy (easy peasy) and pH Bravo test, a barium swallow (the receptionist said it would take 1-2 hours, it took less than 10 minutes...), and an esophogeal manomatry (HORRIBLE, probably the worst thing I have ever had to endure in my life.) We have discovered several things. First, I have a 5cm hiatal hernia. I also have a rather weak esophagus; the manomatry test results showed that it was only working at about 15% capacity, but I do not have any problems with food sticking in my throat so my doctor thinks the test results may be off. But, the barium swallow did reveal that anything I swallow comes right back up my esophagus if I'm not sitting/standing up to keep it down in my stomach. I also have gastroparesis, which means I don't digest food as fast as normal people do. Lastly, I had my gall bladder removed 4 years ago (around the time the heartburn started). All of this combined means that it's not actually stomach acid causing the heartburn, it's bile (that is being produced by my liver and going directly into my stomach since there's no gall bladder to hold it anymore) that is being pushed out of my stomach up into my weakened esophagus because any amount of food in my stomach will prevent the bile from going into my intestines due to the gastroparesis.

Whew. Still with me? Okay. So I am having a "partial nissen fundoplication wrap" surgery done on Friday (4 days from now.) My surgeon has written down on my orders that it's a "robotic hiatal hernia repair & toupet" so I think the actual surgery is called a toupet, which is basically a partial nissen wrap. He does not want to do a full wrap because he's afraid I will never be able to swallow anything, and also because of the gastroparesis (if food/gas is blocked in my stomach on both ends, it will be like a big balloon that just keeps getting more and more pressure applied to it from the inside and eventually it could blow the wrap out entirely.)

I am nervous but also very excited and optimistic about this surgery. Supposedly the toupet is easier to recover from than a full wrap and I will be able to get back to eating solid foods faster. The surgeon did still say liquid foods only for 2 weeks after the surgery. I also cannot wait to not wake up with a choking feeling, which is the regurgitation that should (fingers crossed) stop after the surgery is done.

So my main questions for those of you who have had the surgery are:

Did you have to have an enema, foley (bladder) catheter, and/or NG (Nasogastric) Tube for your surgery? I am terrified of all of them. I had a foley catheter inserted once (for the most ridiculous reason) and the result was not pretty. The nurse did not know how to properly insert it, I bled a lot, and ended up with a UTI when I got home. I have never had an enema or an NG tube but if the NG tube is ANYTHING like a manomatry (!!!) I am not sure how I am going to handle it. Especially if it's in for 1-2 days! (which is what I've read on some websites.) At least the catheter and enema would be removed/over relatively quickly.

What are some good food recommendations for right after the surgery? So far my surgeon has suggested:
Ensure, chicken broth, popsicles (without chunks of fruit), ice cream (with no chunks), tomato soup, juice, gatorade.
I'm also wondering if very soft, pureed, well-strained vegetables (like squash or potatoes) mixed with liberal amounts of water/broth would be okay. Or jello, pudding, yogurt, or things of similar consistency (maybe blended with some liquid to thin them out?)

Lastly, if anyone has anymore advice or wants to share their experiences, please feel free. This is only the second time I have ever had surgery (the gall bladder removal being the first, which seems positively routine compared to this) so even things that may seem obvious or that "everyone should know" would be appreciated.

Thanks. :)
Posted 4/23/2013 12:50 PM (GMT 0)
Hi Maggie and welcome to the forum.

A bunch of us have had the Toupet. It's just like the Nissen except it only goes part way around the esophagus. I had this because of a wimpy swallow. The recovery is no different from the Nissen. If you don't have a whole bunch of other problems read the posts by those who recovered quickly. You can find other posts on Toupet by putting the word in the search box at the top of the page.

Get a few clear liquids on hand in case they want you to stick to those for a few days. I had clears for about a week. After that you can go with "whole" liquids which is just milk added. Most of us don't get on soft foods right away, depending on the doctor. With a weak swallow they won't want you to push it. If you're hungry, just eat every hour or two. This will pass! There are Nissen Diets on the web.

Since you've had gallbladder surgery there will be adhesions, so the surgeon will have to lyse through them. If the hernia isn't too bad it won't pose any unusual problem.

You should expect to be ordered a complete gut prep to clear everything, not just a little enema. The catheters will be inserted while you are asleep. Most people don't even notice them. You'll get IV pain meds which make it much easier to tolerate the tubes. Just don't swallow.
Posted 4/23/2013 6:54 PM (GMT 0)
Maggie-

My experience with 3 of these plus an esophagus tear surgery is that it's hit and miss on the NG tube. I had it with my 1st nissen, tear surgery, and 2nd redo nissen. I had a catheter with all 4, but it was removed the next morning with my 1st nissen and 1st redo. I didn't have to do any bowel prep for any of these surgeries and am not sure why anyone would need to unless you were very constipated right before surgery.

The NG and catheter id put in after you are asleep. A catheter is basically always put in due to the length of surgery and the position of you and the surgeon. Some people have reported it being removed in recovery.

The only time I had the NG tube more than a day was with my tear surgery and my last redo that was 6 months after my tear surgery. Those were exceptions due to how much trauma my esophagus and stomach had been through in 6 months and I was in the ICU for a few days with both.

Look forward to welcoming you to the Wrapped Club soon.

Take care,
Bill
Posted 4/23/2013 8:59 PM (GMT 0)
I decided to call my surgeon's nurse and ask her about a few things.

First I will have a catheter, but it won't be put in until after I'm under anesthesia and it should be removed while I'm in recovery.

Second the surgeon typically does not use an NG tube. Only in very severe situations which he is not anticipating for mine.

Third there will be no enema/bowel cleansing/whatever. Just no food or liquid after midnight the night before.

Last she did not anticipate any complications due to my gall bladder surgery.
Posted 4/24/2013 7:46 AM (GMT 0)
MaggieTheKatt

I had my gallbladder removed about 1.5 years before I had my 1st nissen and it didn't cause any issues. What the nurse told you is pretty much the norm for this surgery.

Take care,
Bill
Posted 9/11/2016 2:25 PM (GMT 0)
I had my 2nd lap nissen on September 1st. This was a partial. My first was 10 years prior with. correction of a large hiatal hernia and was a full wrap. I had been on proton pump inhibitors for 14 years but due to waking up strangling in the middle of the night, I was highly encouraged to have surgery. I was told after this recent surgery that my stomach was up in my chest cavity and I had a lot of scar tissue that was removed. I had a feeling of mild pressure in my throat for approx 4 months before surgery. During the tests prior to surgery, I was told that top 1/3 of my esophagus was not working although it had all been working before I had the initial surgery. Although it felt different to swallow, I did not have any problems eating. I had told my surgeon I wanted a full wrap due to not wanting to deal with reflux but she made the decision to do a partial instead. My first surgery, I was told I would need to be on a soft diet for 4 weeks but I was not able to eat normally until 5 weeks. This time I was told to be on a pureed diet for 6-8 weeks. I was on a ventilator during surgery which she told my husband would be a 2+ hr surgery. It was 6 1/2 hrs. I'm a 64 yr old female. When I went in my O2 saturation level was 99%. After surgery it was dropping to 83-85%. They said this sometimes happens during surgery, my lungs had partially collasped around the edges. I had to do breathing exercises to get my O2 levels up. My swallowing has improved. I no longer feel pressure. I weighed178 and 5'3". I've already lost 10 lbs in one week. I intend to get the weight off as that is what caused most of my problems to begin with and I will eat only small meals which I totally ignored after my initial surgery. Losing weight if you are overweight and eating small meals is the key to not needing repeat surgery. I was on a clear liquid diet for 4 days and had broths, popsicles and jello, then put on a pureed diet and could have anything pureed, meats included, which I'm choosing not to eat. The first time i was on a soft diet right from the start and given grits the day after surgery. I spent one night in the hospital, the first time and had a very quick recovery. This time i stayed 4 nights and they left it up to me if i wanted to stay longer, due to the oxygen problems. It is taking me longer to recover from this one but I'm beginning to feel much better. Take good care of yourself and Good luck with your surgery. Hope this gives you some insight. Oh, my catheter was removed before I awakened.
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