Bill,
The Modified "Short Floppy Nissen Fundoplication" was specifically developed to overcome two issues occasionally observed in the surgical patient outcomes of the Classic Long Wrap Nissen Fundoplication procedure (5 to 6 cm long at the union). These undesirable patient outcomes, first observed immediately after surgery and remaining permanently unresolved thereafter, were:
1.) the patient's inability to belch or expel stomach gas orally......
2.) moderate to severe dysphagia.......
The group of bariatric surgeons who worship at the altar of the "Church Of Short Floppy Nissen" felt that by making the length of the fundoplication "union" no more than 2.5 centimeters long and constructing a loose collar of stomach fundus muscle surrounding the esophagus, these two above stated problems would be resolved.
In my previous comments, I said that the real cause of these two undesirable "after effects" IS NOT DUE TO the length or the tightness of the Classic Nissen Fundoplication wrap; but rather the "sub-par" training, poor skill-set, and overall incompetence of the bariatric surgeon. In support of this argument, I point out that these recently discovered issues of permanent dysphagia and the chronic inability to belch trapped stomach gas were virtually non-existent during the era when renowned surgeon Doctor Rudolph Nissen performed his original procedure on his own patients.
You stated that your Nissen Floppy "union" is most likely 2.5 inches in length. This would be 6.35 centimeters - close to being a Guinness World Record length for a Nissen Fundoplication Procedure!!! The only "Long Floppy Nissen Wraps" I am familiar with, have all been performed overseas - not in the USA. Here, most all Floppy Wraps are, by definition, 2.5 centimeters or less in length and are considered "short."
Please, do some research on your own and see if you can prove me wrong! Contact your surgeon and ask him to confirm the procedure he used on your behalf and the length of the "union." It is my educated guess that either you are mistaken about
the length of your wrap (confusing inches with centimeters); or, you did not get a "Modified Floppy Nissen Fundoplication" procedure because as I stated earlier, most all Floppy wraps performed in the USA are "Short Floppy Wraps" 2.5 centimeters or less in length. This is a fact, not my opinion.
In the past, I DID NOT SAY that every Short Floppy Nissen Procedure under the sun, would, under conditions of stress, necessarily "fail" or tear apart at the stitches. To the contrary, I noted there are multiple variables that influence the final long-term outcome of gastric fundoplication surgery.
Today, after more thought and review, here is a clarification of what I think:
1.) A Short Floppy Nissen Wrap, if constructed with a minimum of three (3) non-absorbable sutures at the union that are positioned correctly penetrating the fundus muscle tissue deeply and same sutures being "tied off" properly by the surgeon, may in fact be durable enough to provide a permanent "fix."
2.) When subjected to "prolonged stress" like repeated retching, coughing, and vomiting; the more stout and mechanically robust Classic Nissen Fundoplication {with a larger sphincter valve muscle mass} is the superior choice for long term survivability of the procedure. I believe that SIZE MATTERS and the bigger the muscle mass at the union, the stronger the new mechanical valve created by the surgeon. As a matter of fact, I believe the vast majority of bariatric surgeons would not dispute this argument, but would non-the-less resist providing their patients with this surgical option for political and personal reasons.
A "Tension-Free Gastric Fundo Wrap" is an interesting concept that has no universally accepted definition amongst the bariatric surgical community. Some surgeons claim that a "tension free" 360 degree wrap has only one requirement - the surgical separation and dismantling of the short gastric blood vessels between the spleen and the stomach fundus. Under this definition, a Classic Long Wrap Nissen Fundoplication where the short gastric blood vessels between the spleen and the stomach fundus are separated could technically be referred to as being "tension-free." Other surgeons consider that only a "Floppy Nissen Fundoplication" with a loosely formed stomach muscle collar surrounding the esophagus and the surgical separation of the short gastric vessels can be considered "tension-free." Finally, there are surgeons that consider a "Floppy Nissen Fundoplication" without any dismemberment of the short gastric blood vessels to be a "tension-free" wrap.
As I stated in previous comments, I believe the utilitarian advantage of a Short Floppy "tension-free" gastric fundoplication procedure is limited to the first 6 months, post-op. When Classic Nissen Surgery is performed by a competent surgeon, any undesirable "after effects" have typically resolved spontaneously within 6 months. Therefore, there exists zero "added utility" for the Short Floppy tension-free procedure beyond this 6 month time frame. In support of this, I cite my own personal Non-Tension-Free Classic Nissen Surgery where there existed no remarkable toward effects after 6 months.
You are correct when you say that the surgical community is "divided" about
this issue of exactly how to "standardize" the Nissen procedure. When it comes to applications where a full 360 degree wrap is indicated, frankly, there is no such thing as a single surgical approach accepted and practiced by an overwhelming majority of doctors and surgeons. Thee exists a great deal of controversy regarding specific methodologies.
I have NOT based my arguments and opinions on any one study or report. My opinions are based on my research from a multitude of different sources including several hours of video footage of actual Nissen Fundoplication Surgeries; from my own personal experience with Classic Nissen Surgery as a patient; from my background in mechanical engineering and physics; and from common sense and sound logic. I view the subject matter of this particular discussion {e.g. the gastric fundoplication durability issue} as an exercise in problem solving. And, my conclusion is that for those patients who are good candidates for a full 360 degree wrap, Doctor Rudolph Nissen solved the durability issue with his original fundoplication procedure.
In the future, I hope for a strong resurgence of popularity amongst the masses for Doctor Nissen's Classic Fundoplication Procedure; similar to the resurgent popularity of the "Coca-Cola Classic" soft drink!
Concerning the "comfort level" of other people participating with this thread, when I have made mistakes or errors, I have been cordial and positive and corrected my misstatements by formally admitting these errors publically. I have no "axe to grind." But, I will admit, I can become very passionate about
causes where I believe I have the strongest arguments comprised of both verifiable facts and personal opinions. I hope my opinions serve as "food for thought" that motivates others to do some research on their own, "thinking outside the box." Imagine "what if" becomes "eureka."
I consider myself to be a good person and as such I bear no malice or ill-will toward anyone. I wish only the best of luck and success for all of those individuals who come here to seek advice and the brotherhood of common cause. If I have offended anyone by being insensitive or rude, I sincerely apologize for my unintentional slight.
By the way, I view my own "healthy skepticism," regarding bariatric surgeons, beneficial to those who have not yet made a decision concerning their GERD options. And, isn't the American Citizenry being "better informed" {in this case, through my skepticism and challenges to the current mainstream paradigm} the primary function of this thread after all???
Sincerely,
JohnnnyRebel
Post Edited (JohnnnyRebel) : 6/5/2014 10:34:28 PM (GMT-6)