Nissen Fundoplication

Hi Lou,

Welcome to Healing Well!  Sorry it took so long for you to get a response to your post!  We try to get to all new members, but sometimes people fall through the cracks.  My apologies!

I had the Nissen surgery nearly five years ago, in February 2009.  I can tell you that once the surgical healing is complete, you won't have a bit of trouble walking.  I'm a fitness walker (61) and love hiking over hill and dale.  I do this with enthusiasm, and walk very fast.  The Nissen has done nothing but improve my fitness, as reflux was affecting my lungs very badly before surgery.

Yes, you do need to get the testing.  Otherwise, you might get the surgery for no reason!  It is always horrible to be off the PPIs for that week before the PH test, but it's a necessary evil, and you'll make it through.  For most of that time you can take Ranitidine (Zantac) and Maalox/antacids.  There is a period close to the day of the test when you're off everything.  Many of us have made it through the horror (really it's doable...not fun, but worth it in the end) and lived to tell about it.

As far as swallowing issues (motility), there are versions of the Nissen (partial wraps) that work well as far as reducing reflux, but allowing swallowing to occur, even with problem swallowers.  Several who post/posted here have had great results with partial wraps.

So, go for those test, and get the surgery if you're deemed a good candidate. It can greatly improve your quality of life.  The recovery is not easy.  The first couple of weeks are especially challenging, but if you're prepared and have a good attitude, you'll do just fine.   

It takes six months for most of the healing and a year for the rest. You will gradually improve over this time, so it's not all that difficult once you get past the early stages.  As Bill, another moderator here, says, "It's a marathon, not a sprint!"  Here's a link to my early recovery journal. It'll give you an idea about what the recovery looks like:

https://www.healingwell.com/community/default.aspx?f=45&m=2183443

Glad you've joined the forum!

Best wishes,

Denise

Hi Denise or other gerd moderator,

I have absorption issues (including gas and bloating) now after 15 years of ppi's and i have lost a lot of weight.I am getting results of mannometry this week.Do you think i can still be a good candidate for fundoplication  or will they say it's too late?Have you heard of people getting rid of those issues with the surgery and eliminating the pills which i think is a key issue for me or at least for a number of years?What do you think from your experience?

Louis 

Hi Maria,

Thanks for the reply.I had mannometry and 24 hour ph test on November 3 and will get formal results with the specialist on tuesday.However the technician told me that my swallows were ok although a few double ones likely due to LPR.Also the test confirmed that i have acid reflux in the esophagus about 1-2 hours after each meal.Is it caused by hiatus hernia or weak LES that she couldn't confirm at the time as i do have a small hiatus hernia.I think she mentioned the hernia was part of the cause but it is related.

My main concern is i have developed absorption issues which are in line with what we read on the internet sites about ppi's.So i am hungry and eat food but i am not getting the proper energy levels with the food intake.So the pills are basically making me weak and prone to osteoporosis and infections.So for me it is key to get the surgery but also get off the pills so i can get back to normal stomach acid secretions within reasonable time and hopefully that would solve my absorption issues caused by 15 years of ppi's.I know that the surgery would help the reflux,esophagitis and LPR.I had endoscopy but no barium swallow.Why barium swallow if they perform endoscopy?

If i am selected for surgery that would be my first question what type of wrap do you intend on doing and why?I am 57 and hope not to go back more than needed.
I hope your wrap comes out all right.I read in other blogs that some people have to take pills for a while after surgery until the wrap settles.Are you on the liquid mushy stuff now or still on liquid?
Louis

Hi Louis,
Sorry it has taken me so long to get back to you. Things have been very busy at my house! It's never too late to get a fundoplication. If your testing shows you're a good candidate, it will help you. Some of the scary things you read on the internet are written by people who are in recovery, and don't realize that with time, their symptoms will improve. Many surgeons don't properly prepare their patients for what to expect post-op.

It's no an easy recovery, but if you go into it with the right attitude you'll do fine. It takes six months for most of the healing and a year for the rest. It takes patience and trust. If you can surrender to your recovery, and follow it where it takes you, you'll do fine. Those who struggle against what is, have a hard time of it. If you accept your recovery and "go with the flow" you'll do fine.

As far as getting off PPIs...I suspect you're taking maximum doses. Is that true? If you are suffering bad reflux and the accompanying symptoms, the surgery will help you. Especially if you have fairly high levels of reflux. I had very low levels that were affecting my lungs, and the surgery helped me greatly. I will say, thought that I am now continuing to take a small dose (compared to pre-surgery) of PPI before dinner daily, because my asthma doc wants to ensure that I'm protected from even small amounts of reflux.

You need to know that even with surgery, your reflux will not be taken to zero. If the surgeon ensured you would have zero reflux, the wrap would be so tight that you wouldn't be able to get food past it and into your stomach. Their goal is to bring your reflux to "normal" levels. While I am an advocate for the surgery, you need to be aware of the fact that you can still get reflux, and in some cases post-op patients do take some much smaller dose of PPI or Zantac even after being wrapped. Not everyone by any means, but it's no guarantee that you will NEVER have the need again. Just being real here.

Many who have been members of this forum have had partial wraps due to swallowing problems, or even surgeons who just prefer the procedure due to the fact that it eliminates or lessens some of the possible negative side effects like bloating. They work just fine and people are happy with the results.

Just curious...do your doctors blame all of your absorption issues on PPIs? If the problem is only caused by PPIs, then the surgery will definitely help. It may take some time for healing to occur, but over time you should see improvements. The thing is, the health problems caused by GERD don't generally go away immediately...they didn't happen overnight, and they have been with you for long time, so it will take time for the healing to occur.

Have you ever had a GI doc do a compete workup regarding your absorption problems? Are there any other possible causes in addition to PPIs? Just wondered what they have to say about the issue.

Good luck with all of this. I know it's hard to wait for the testing results and to finally make a decision about what to do! Hang in there!

Best wishes,
Denise

Hi Jerry,

This website is marvelous.You have made my day.I am seeing the  gastro enterologist on tuesday to get the results of my mannometry and ph test and hopefully a quick referral to a surgeon.I expect that he will try to delay me again with more tests and long turnaround but i have had numerous blood tests,a catscan,showing nothing critical so my absorption issues (as you had) have to be the long use of the pills and needs to be addressed soon before other immune issues come on as i lost 30 pounds in about 2.5 years.Curiously the first 10 pound was voluntarily to improve my diet and my reward was that the acid reflux became double worse and then the absorption issues came up and i lost the other 20 pounds involuntarily (although the gerd diet likely pushed that a bit),i even had often two bowel movements  per day which i would never have before.

So not only do i have the esophagitis and LPR but i am convinced that the ppi pills are making me sick (but try to convince the doctor and specialist of that impossible as the ppi are the miracle pills).I also note you had chronic gastritis issues which is also a concern of mine as one spot was quite bad and was wondering if the surgery could create infection or something.But it seems like you are doing all right with the ppi's to cover for a month.

A few questions:

1)i assume you had the full nissen fundoplication (5 incisions therefore laparascopy)?

2)how is your shivering and weight management coming along?I am in northern canada and i tell you that it is -17 tonight and my lower limbs have very poor circulation (some of that restless leg syndrome i think during the night too).Did you have a bit of that too before the surgery as you had lost weight.

Again thanks for writing to me and i now feel much more confident going into the meetings with my doctor and the specialist.I am in Canada and the approach is to go with the meds until they don't work and i believe i am there. 

Thx.

Louis           

Hi Maria,

I think the medical system in Britain is similar to Canada where basic treatment is open to everyone but i am not sure.

The approach that i was given with GERD is you try the medication and if it works you go as long as it works.If it no longer works you can apply for surgery but it has to be last resort and after you have been selected as a good candidate thru the endoscopy/mannometry and 24 hour ph test.

I was diagnosed with a small hiatus hernia when i was 33 and i believe the ppi's were just coming on stream at that time and the specialist told me that i could be on those pills for life!Never was the option of surgery mentioned with the size of my hernia.But i believe some of your issues i had too without the retching.I lived about 7-8 years without pills only gaviscon when i had esophagal spasms (quite painful) and the i had about 12-13 years good years with the pills (one per day) and then about 2 years ago reflux came worse and digestive issues started the reason for me consulting.

I think your issues came quite abruptly and it looks like your doctors agreed that you were an ok candidate for surgery.Here if they don't believe the surgery has a reasonable chance of success i am sure they can turn me down.If my symptoms were mainly upper gastric i think it would be more cut and dry if the tests are good but because of my digestive issues it will be interesting to see what comes out.I will know this week but another fellow on the blog had similar issues than mine and he seems to be recovering happily from the surgery.

Good luck with recovery.I'll be interested to see if your partial wrap requires ppi's for a while.

Cheers.

Louis     

       

Hi Maria,

Not sure if this procedure is available in private in Canada as i think it needs to be done in hospitals.If it is it would be very expensive.

Can you tell me what the demeester score is again and how it influenced the surgeon's decision?

Thx.

Louis 

Hi Louis

The 24 hour impedance test works out the demeester score. Anything above 14 is classed as abnormal and mine was 33.9 which is very high. Which proved that I had acid reflux. I didn't know then what had caused this but have since found out that I had a hiatus hernia.

The surgeon said that I could have surgery even before he knew I had a hernia. He does specialise in this type of surgery.

Do you have private health service in Canada ? If you do I'm sure they will do this surgery privately. I don't know how much it would cost privately in Canada but in the Uk privately it costs about £6500 - £10000.

I'm sure that you'll get recommended for surgery especially as you've been on ppi's for so long and you have absorption problems . Let us know when you get your results and how you get on.

Maria

Hi Louis

I'm pleased that you got the results that you were hoping for.

Your hiatus hernia is sliding - 98% of the hernias are sliding ones. My hernia wasn't seen on the endoscopy but eventually found on a barium swallow. I too was told it was only a slight hernia but during the operation the hiatus (hole) in the diaphragm was quite large and needed 3 stitches. I believe that my acid reflux was caused by the hernia so even if they are only small they can cause problems.

You also have a weak sphincter which is obviously letting acid through. On my test my sphincter didn't show up as being weak although I've found out that it can just go weak and relax as when it likes.

So with your weak sphincter and a hiatus hernia I can't see how they can refuse your operation. Hopefully you'll get a good outcome and get the surgery and all will be well.

Take care

Maria

Thanks Noelle.I am on double dose of Nexium at 40mg each and i still don't see much progress on LPR,maybe slightly better than when i first got it about 6 months ago.But i have been on ppi's for 15 years.

I googled LPR versus fundoplication and found a few articles showing about 75% of patients see good improvements on LPR after surgery so that is encouraging but i need to look  more as nexium does not help my LPR very much and would like to know why...

The pharmacist told me tonight that Strepsils will likely numb the throat and i read that this is not recommended for LPR so he recommended TUMS.

As my swallowing is on the lower end of the range i may be referred for partial fundoplication.We'll see.I have an endoscopy on the 16th and that may provide more rationale for the surgery.

Let me know how your progress goes.

Ciao for now.

Louis      

Hi Denise (Dencha),

I am trying the health/anxiety links that you provided on this website but cannot seem to get them to open.I copied and paste them in the browser and it's not working much better.Ca you help?

Thx.

Louis  

Hi,
I'm 33 years old and at this moment I'm laying in bed doing the 24 hrs phone test. I've had heartburn/acid reflux for year, have a hiatal hernia and Barrett esophagus so my Dr is leading me towards surgery. Earlier today I had the esophageal manomentry and that was help. I never want to do thAt again. As I'm laying here though I'm having my usual reflux(I guess is good so they see what happens), but I also am having the chills and just can't get warm. Has anyone else experienced this?

Thank you