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Does vomiting undo a nissen fundoplication?

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Posted 6/3/2013 12:09 PM (GMT 0)
Hey all, I had a nissen fundoplication (partial wrap) 3 months ago and the surgeon told me that vomiting will undo the wrap. He said under no circumstances could I vomit or gag for 3 months after the surgery, and that I must prevent any episodes of violent vomiting for the rest of my life otherwise the wrap will be weakened and the reflux will return. He said I'll have to stay away from consuming things that may make me sick (ie: alcohol) , and if I ever begin feeling nauseous to go straight to the chemist and buy anti-nausea pills, and I'll have to do this for the rest of my life. Is this true? I've now been told I need a colonoscopy, and the preparation requires drinking fluid that has made me violently sick in the past. I'm scared to have this procedure done as the prep is likely to make me vomit a lot and I don't want to undo the nissen. Was my surgeon exaggerating? Has anyone here had their wrap come loose from being sick?
Posted 6/3/2013 12:43 PM (GMT 0)
Hi Jinx77,

Actually, your surgeon's directions regarding vomiting after a Nissen are correct.  At 3 months, you are at great risk of damaging your wrap if you vomit.  Do you need to do the colonoscopy right now?  I had one scheduled for shortly after my surgery, and rescheduled it, because I knew that the prep would be hard on my healing stomach.

I would disagree with one of your surgeon's comments...you shouldn't go to the chemist when you feel nauseous...you should go before that.  Anyone who has a wrap should have anti-nausea drugs on hand at all times.  I carry them with me wherever I go, just in case.  I have a tendency to get sick without warning.  By the time you make a trip to the drugstore, you may have vomited multiple times.

I have read several incidences of vomiting during early recovery (which is where you are right now) that destroyed the healing wrap.  It's definitely not worth taking a chance doing your colonoscopy prep if it means you're putting your surgical outcome at risk.

Vomiting and retching/dry heaves are equally hard on the wrap.  You should be thankful that your surgeon gave you that warning. You wouldn't believe how many surgeons never mention the danger to their patients, and who fail to provide them with anti-nausea drugs.  (By the way...I can't believe that your surgeon gave you that warning but didn't give you a prescription for the meds.)

I've vomited three times since my surgery four and a half years ago.  I'm one of those who was told I wouldn't be able to vomit, but did.  Each of the times, I vomited suddenly and didn't realize I was going to be nauseous.  I immediately used a Compazine suppository (once I'm nauseous, a pill in my stomach won't stay there), which kept me from vomiting again.  Repeated and violent vomiting are the culprits. 

Discuss your worries about vomiting with your GI doctor.  He/she should want you to protect your healing wrap.  There may be a way to prep without becoming nauseous.  Whether or not you get your colonoscopy at this moment, be sure to ask your PCP, GI, or surgeon for nausea meds.  I have Zofran and Compazine suppositories.  The Zofran is good for that nagging nausea that can occur, and the Compazine for all out stomach bugs.

Glad you asked your question!  It's a very important one.

Good luck!

Denise

 

Posted 6/3/2013 3:12 PM (GMT 0)
Thanks for your detailed reply Denise :) I am scared to have the colonoscopy now, haha! I have booked an appointment with the surgeon to talk over my options for prep. If they think there's a chance I may vomit I will tell the GP that I'm postponing the colonoscopy for a few months. It is for an unrelated bowel issue I've had for many years, it would be good to get to the bottom of it (no pun intended!) but I would hate to risk reversing the surgery which has been a big help to me. How many months does it take for the tummy to be fully healed after the surgery?
Posted 6/3/2013 3:20 PM (GMT 0)
Hi Jinx,

It takes 6 months for most of the healing and a year for the rest.  If you can put off the colonoscopy, knowing that it makes you sick and puts you at risk for vomiting, go for it.  Perhaps they can give you something to take away that risk, so you can go forward with the procedure.

My first vomiting episode was at 1 year.  As I said, though, I only vomited once, then took anti-nausea meds, so it wasn't a repeated assault on the wrap.  Even when your wrap is fully healed, you'll want to minimize the effects of nausea and avoid vomiting as much as you possibly can.  A severe and repeated vomiting episode can damage even a fully healed wrap, so I can't emphasize the importance of nausea drugs too much.

I'm glad you're going to meet with your surgeon before the colonoscopy.  Before you do anything, though, ask your GP for some anti nausea drugs to keep on hand.

Let us know what you decide to do!

Good luck!

Denise

Posted 6/4/2013 6:07 AM (GMT 0)
I agree with Denise, especially about having anti nausea meds always on hand. I take them with me every where I go.
I have had the dry heaves a few times and that didn't damage any of my wraps, but hurts a lot.

Take care,
Bill
Posted 6/4/2013 6:02 PM (GMT 0)
I agree too.

I had a vomiting (just bad heaves) episode while my wrap was healing and did rip the hernia some. My stomach is partly above the diaphragm again.

But I still can't vomit and have no reflux. I had flu, went to ER, and I suspect nobody but my husband believed I was having the heaves because nothing came up.

I carry Zofran with me all the time.

If the prep is known to make you sick ask for a different one. There are dozens now. Insist!
Posted 6/4/2013 8:29 PM (GMT 0)
Slightly off subject, but does anyone know about vomiting during 24 hr pH monitoring??

MMM
Posted 6/5/2013 4:00 PM (GMT 0)
Hi MMM,

I've never heard of anyone vomiting during a 24 hr PH monitor. I would think it could dislodge the probe.  I've heard of people who pulled their own probe out when they couldn't tolerate it, so I'd guess with vomiting, the probe might need to be replaced by the doctor's office again.  Good question!

Take care,

Denise

Posted 6/5/2013 9:25 PM (GMT 0)
Thanks Denise. I need to do the tests but I fear nausea will prevent me from even getting it in place cry
Posted 6/11/2013 7:09 PM (GMT 0)
Hello,
I have a concern: i only had a loose Nissen done on April 24 of this year. I had thrown up twice but not violently is was just like mucus coming out. My surgeon told me to experiment to see what foods i can swallow. So i did that twice and again i threw up what i tried to swallow until it came out. I didn't try eating those things again. My concern now that i read some posts about vomiting is dangerous to the wrap, should i be worried that my wrap came undone? Recently, like a few days ago i have become nauseous and i never was before this and it will not go away, even with Zofran. Every time i eat i get nauseous and at times it gets unbearable. I went back to the surgeon and he is concerned that my stomach is not filtering right, that it might be just sitting there and expanding when i eat and not filtering the food the right way and that's the reason i am getting nauseous. i am not really sure of what i am supposed to be eating right now or how much during each meal. I am not getting any straight answers from the surgeon, he tells me eat what i can swallow and eat until you feel full. But that's a problem even though i had this done i don't feel full until its too late and i am in pain from eating too much. So what should i do?
Posted 6/11/2013 7:56 PM (GMT 0)
Hi believeinyou,

Welcome to Healing Well yeah yeah yeah Wrapped Club! yeah yeah yeah When food gets stuck and you "vomit" it's really more like coughing up a "hairball" the way a cat does.  You don't have to worry about the times you've done that.  Still, I'm concerned with the lack of information and support provided by your surgeon.

When he says "eat whatever you can swallow", does he give you any guidance as to how to choose the foods you eat?  Here is a rule of thumb that should work for you.  Take small bites and chew, chew, chew until whatever it is you're eating is a liquid, creamy consistency.  Don't eat anything that doesn't chew to a liquid.  If you find whatever it is will not chew completely, spit it into a handy paper napkin and don't swallow it.  Here are a few resources to help you choose the right kinds of foods to eat:

http://www.preopguide.com/PostFundoDiet.html

http://www.upmc.com/patients-visitors/education/nutrition/Pages/diet-after-nissen-fundoplication-surgery.aspx

http://www.nissenfundoplication.com/nissen-fundoplication-diet

https://healthonline.washington.edu/document/health_online/pdf/Esophageal_Diet_After_Surgery_3_11.pdf

 If you are having difficulty swallowing chunky foods (and you will always have more difficulty with this, as you've had an unnatural barrier placed between the esophagus and the stomach) the be sure to stick strictly to foods on the soft diet list.  Actually I found crispy things (like saltines) chew to a liquid easily. After you're fully recovered it's not as big an issue, but you'll always have to eat more slowly and chew your food completely.

Stay away from iced drinks, carbonation, and straws. 

It is totally normal to need to chew your foods to a liquid at your stage of recovery.  It takes time for swelling to completely resolve, and healing takes a full 6 months for most of the healing and a year for the rest. 

Your stomach has been through a lot, and nausea is its way to say, "Slow down!"  Listen to it, and treat it gently for a while.  Stay away from irritants like spices, acidic foods, and alcohol until things are feeling better for a while. 

I'm glad to hear you have anti-nausea drugs.  Be sure to take them with you wherever you go.  As I've said, it is very dangerous to your wrap to vomit or retch repeatedly.  Protect it with anti-nausea drugs.  The Compazine suppositories work great with a real stomach bug.  It's worth having around, just in case.  It comes in a generic form, so it's affordable.

If you get feeling full very quickly, then it is good advice to eat until you're full.  If your body allows you to overeat, then you need to control your meal quantities yourself.  I'm sure it's hard on your stomach to be overly full, and it puts more pressure on your healing wrap.

Glad you've joined the forum.

Take care,

Denise

Posted 6/11/2013 9:08 PM (GMT 0)
Dear Dencha

thank you for the information, i don't have problems swallowing like baked chicken and hamburger as long as it is in small pieces. I don't like too many things so when it comes to like bread and pancakes or sandwiches i remind myself that it is not worth the pain to eat them. Knowing that i probably can't swallow them or keep them down. I stay away from things like that. I think my problem is that i have been eating a lot of things with spices in them that are too spicy. Like the taco hamburger helper and three cheese queso or chicken wing dip. maybe thats why my stomach is acting the way is now, but how will i get it to calm down? i was told to drink a lot of water, but also i am not moving my bowels that much either, its like once every four days or so and even then not that much when i do go. one last question how would i know if the wrap has come undone or has loosened? i don't want either to happen so i want to learn how to portion my meals to where i am not over eating or stretching my stomach to loosen the wrap.
Posted 6/11/2013 9:23 PM (GMT 0)
Hi believeinyou,

If you have only coughed up stuck foods a few times, I wouldn't worry a bit.  I think you are right about the spice irritating your stomach.  Remember that your wrap was created out of the top part of your stomach...it was stretched and wrapped and stitched.  It is not happy with you right now, and you need to baby it along. 

Often when people get to the stage when they can at more foods, they overdo it, which causes them problems.  Just stay away from those spicy foods, take small bites, and chew, chew, chew.  If your stomach is irritated you won't want anything that isn't smooth to enter it.  Part of stomach digestion involves the stomach muscles mashing the food.  If there are chunks in there, it could irritate your stomach further. 

It takes time for it to heal, but if you baby it, it will help.  In order to get your bowels moving, the idea of drinking water is a good one.  Has your doctor recommended Miralax or something similar?  You're probably not eating as much, and you're not moving as much--both of which can cause constipation. 

Good luck!

Take care,

Denise

Posted 6/11/2013 9:46 PM (GMT 0)
dencha,

yes i had someone suggest miralax to me and i do have some at home, that won't irritate my stomach though? i was also thinking about taking ex lax pills to help me go also but i didn't know if that would irritate anything.

yes i will baby my stomach for awhile and i am definitely stay away from the spicy stuff, it is just not worth it. you helped me out alot and i thank you.

i am going for an upper GI tomorrow morning to see if my stomach is filtering right or working at all. so i hope that everything is ok because i don't want another surgery.

i will work on making my stomach happy and learn how to portion my meals better
Posted 6/11/2013 10:30 PM (GMT 0)
Hi believeinyou,

That sounds like a good plan.  I'm not sure what the directions are with Miralax, but if you can take it with food, it would probably protect your stomach from any untoward effects.

Good luck with your testing tomorrow!

Take care,

Denise

Posted 6/12/2013 3:46 AM (GMT 0)
Limit your intake to 1/4 to 1/2 cup several times a day. Stay away from solid meats and soft bread for a few months. Toast and ground meat are okay. Wait until you feel the food go through the wrap before taking another bite.

Take care,
Bill
Posted 6/12/2013 8:30 PM (GMT 0)
I take Miralax (or the cheap generic) any time, with or without food, mixed with anything like coffee, juice, soup ... I take a full dose when I am not eating enough vegetables, don't need it if I eat one meal of just vegetables. It's not addicting, doesn't go into your system, just pulls water into your gut.

Dulcolax, Ex-Lax, any laxatives can be habit-forming. They should be taken only for a short time and only according to the directions on the label. That's the stuff you may have taken as part of a bowel prep.

I hate preparing vegetables to the point of not eating them if I have to peel, boil, etc. A nice bag of microwave in the bag mixed veggies (not the ones with rice, potatoes or pasta) works very well. The ones with green leafy veggies - usually broccoli - give you your vitamin K too.
Posted 6/12/2013 10:00 PM (GMT 0)
Alcie has lots of great advice.  If you're having bloating issues, though, take it easy on the gassy veggies.  Try BEANO when eating veggies, as it helps keep gas from forming.
Posted 1/29/2014 11:46 AM (GMT 0)
Ladies and Gentlemen:

Herein lies the major reason a modified Nissen Fundoplication surgery called the "Floppy" is worthless crap and should be avoided. The durability and resistance to stress is terrible.

Fifteen years ago I had a laparoscopic "Classic Nissen Fundoplication" performed by an excellent surgeon who knew what he was doing!! Immediately after my surgery I could burp and belch gas effortlessly.

____________________________

The Durability of the Classic Nissen Fundo Valve versus the Floppy Nissen Fundo Valve:


My "Classic" Wrap Durability: For stomach flu, I may get nausea but I am unable to vomit. I am able to vomit for food poising or alcohol poising - without any damage to my wrap. Violent dry-heaving, severe retching, or lifting heavy weights at the gym also has no effect on my wrap - which has more than 100 percent more sphincter valve muscle "in-play" at the "union" where the wrap is sutured to itself around the esophagus. My "Classic Nissen Fundoplication" wrap is over 5 centimeters long at the "union"; with five sutures holding it together.


The "Floppy Nissen Wrap" is typically 2.5 centimeters long at the "union" with three sutures (or, sometimes only two sutures) holding the wrap together. With a 50 percent reduction in the length of the "union" and less sutures holding the wrap together, the "Floppy" valve is much weaker and much less able to withstand "stress" - such as gagging or retching violently. These are the facts. In this case a "smaller" valve is a much "worse" valve from a durability standpoint! The "Floppy" is "sloppy."

Post Edited (JohnnnyRebel) : 2/2/2014 6:32:44 PM (GMT-7)

Posted 1/29/2014 8:32 PM (GMT 0)
Aside from personally having a floppy, knowing dozens on here with them and personally having friendships in real life with two people with floppy nissens as well as reading reports provided to me on studies about floppy nissens, I dont think I buy that you are calling the floppy nissen crap and I think it is disrespectful and harmful to people on this board who are coming here for support and information.
Posted 1/29/2014 8:38 PM (GMT 0)
Stephanie - totally agree. Each case is individual and some people are not candidates for certain procedures. If there were one-size-fits-all solution for everyone, there wouldn't be so many varieties of the same procedure.
Posted 1/30/2014 3:09 PM (GMT 0)
To those of you who view my critical attack of the Short Floppy or "Modified" Nissen Fundoplication surgery, negatively; YOU are taking my factual information presented and real world experience described as a personal insult - and this is wrong.

If you happened to select the Floppy Nissen Fundoplication surgery, that was your choice. But why shouldn't some one else at this forum have the possible benefit of hearing my opinion - based on more than 15 years of "Nissen Fundo" experience??? Wouldn't you want others to have a more "informed" decision-making process where all of the options were put on the table?

Admittedly, "one size" does not fit all. Some people are not proper candidates for Nissen Fundoplication Surgery, primarily because they have other issues in addition to a weak LES.

FOR THOSE PEOPLE WHO ARE PROPER CANDIDATES FOR A NISSEN FUNDO: Let's be honest here. Patients who accepted the Floppy Nissen Fundoplication surgery as a solution to GERD, have made a "trade off." They traded away having the most permanent and durable form of Nissen surgery available (e.g.Classic Nissen Fundo surgery) for the short term "advantage" of having less trouble swallowing food and getting it temporarily hung-up in the esophagus, starting at about 3-4 weeks post-op.

However, if the surgeon performing Classic Nissen Surgery is competent, any short-term problem swallowing food should resolve itself within 6 months - leaving the patient with the most robust and durable Nissen sphincter valve possible. Any advantage the Floppy Nissen Surgery may have provided, initially, typically disappears by 6 months post-op. I am a witness who can testify to these facts. My "classic" wrap is durable and strong. And, starting at exactly 6 months post-op, I could eat anything including doughy breads or bagels without any problem swallowing. Additionally, I have no fears what-so-ever about stressing my body through heavy lifting exercises, or about getting an illness with vomiting. Others in this forum have specifically mentioned they have these fears and worries. This is because of the choice they made in selecting the "Sloppy Floppy" Modified Nissen Fundo Surgery.

Bottom Line:

Anyone who would suggest that having less sutures and a "shorter wrap" (the Floppy) is nearly as durable as as a longer wrap with more sutures holding the wrap together at the "union"(the Classic Nissen Fundo); is in "denial" of the laws of physics and science. That would be like claiming the strength of single-ply toilet tissue paper is equal to the strength of two-ply toilet tissue paper; which is ridiculous!!!!

Doctor Rudolph Nissen is "rolling over in his grave" at this very moment. His original procedure has been "butchered" and "morphed" into something that is barely recognizable as a Nissen Fundoplication.

Post Edited (JohnnnyRebel) : 2/1/2014 9:44:43 PM (GMT-7)

Posted 1/30/2014 7:53 PM (GMT 0)
The "Floppy Nissen Wrap" is typically 2.5 centimeters long at the "union" with three sutures (or, sometimes only two sutures) holding the wrap together. With a 100 percent reduction in the length of the "union" and less sutures holding the wrap together, the "Floppy" valve is much weaker and much less able to withstand "stress" - such as gagging or retching violently. These are the facts. In this case a "smaller" valve is a much "worse" valve from a durability standpoint! The "Floppy" is "sloppy."
Post Edited (JohnnnyRebel) : 1/29/2014 5:13:16 AM (GMT-7)

JohnnyRebel,

I just called my surgeon's office. I had the floppy nissen wrap 2.5 cm with three sutures. I thought it odd they called it the "Classic Nissen Fundoplication." I vomited sporadically for 16 hours straight at 11 weeks. I am fine. You are implying that this will be a redo in the future?

Michelle
Posted 1/30/2014 8:45 PM (GMT 0)
Michelle,

Certainly, I wish you good luck with your fundo. I pray that a "redo" is not needed in your future.

Admittedly, my belief system tells me that your shorter wrap is less durable than the longer ones with more sutures and greater sphincter muscle mass. In my mind, this means "stress" on the "union" could be a potential future issue - or, it may not. It is good you had three sutures instead of only two at the "union."

I cannot predict whether you will need a "redo" in the future. Only time will tell. But, if you already vomited several times and your wrap is still "intact" this bodes well for your long-term success.

I mainly am stating my opinion here for those who have not yet decided about having the surgery; or, to help inform those who may need to have a "redo." - to give them more options. I am not trying to "worry" anyone who has already had the Floppy surgery and has no issues, currently.

I am angry with the surgeons who do not fully explain the options available to their patients. People need to make informed decisions.

Personally, I went through much pain at the beginning of my post-op period. I went to the ER twice with food that was stuck in my esophagus. I really couldn't eat a decent meal without food hanging up to some degree, for 5 months post-op. The "pay-off" is that everything healed wonderfully and I have no restrictions on my activities or fears of vomiting my wrap into pieces. My surgeon was a real gifted artist.

Again, I wish you the best of luck!!!

By the way, any "Modification" to the original Rudolph Nissen Fudoplication Surgery , by definition "excludes" the use of the word "Classic."

Post Edited (JohnnnyRebel) : 1/30/2014 2:10:10 PM (GMT-7)

Posted 1/30/2014 9:36 PM (GMT 0)
Hi Johnny rebel after reading your comments with interest should this include people with motility issues to have the classic. I have spoken with a surgeon and he did mention the words durability but that was before I found out I had a minimal dysmotiliy .
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