My Nissen Fundoplication experience

Hello all! This site has been such a great resource for me while making the decision to pursue surgery, I thought I would share my experience in case it helps anyone else out there in the same position.

My background:

I'm a 34 year old woman in pretty decent physical shape. I'm about 5 feet tall, and 120 lbs. I used to play roller derby, I've run three Tough Mudder races, and I ran a half marathon earlier this year. I'd like to get back to running as soon as I can. I work in an office job as a software analyst. I also have other medical issues including autonomic dysfunction.

I've dealt with heartburn/GERD for many years, but the last 4 have been the worst. The tipping point for me was waking up choking on acid in the middle of the night - I literally felt I was going to choke to death, I could not breathe for what seemed like many minutes.

I was prescribed one PPI after another, and after awhile each stopped working. I've altered my diet and exercise, and tried virtually everything I could find. While some things worked well temporarily, nothing helped for long.

My primary symptom was severe/large volume regurgitation. Any time I ate or drank anything, even water, it would come back up into my throat within a minute. If I leaned over within an hour or so of eating or drinking, I'd feel the acid just pour back up into my throat. I never burped without something coming up with it. It felt like there was no stopper between my stomach and my esophagus.

Getting diagnosed:

After exhausting all PPI options with my GP, I got a referral to a gastroenterologist. Over the course of the last six months I've had two endoscopies, a bravo ph monitoring test, a barium swallow test, and a manometry. If anyone is interested in the details of any of these tests, I am happy to share my experience on those, also. The results of this testing showed I had a hiatal hernia, esophageal dysmotility, esophagitis, gastritis, and duodenitis.

My GI was very realistic about my options, including surgery. I was offered the option to try the only PPI option I hadn't tried yet (Dexilant) and encouraged to try adding an antibiotic to help move the food out of my stomach more quickly. Even with both of these, I was still having reflux, so I was told to add Lansoprazole before meals and Ranitidine at night.

Dexilant was not covered by my insurance, and I was paying $180 a month with the discount card. The antibiotic was giving me horrible stomach cramps within an hour of taking it every day, and causing me stomach pain throughout the day. And on top of all that, I was still taking two other PPIs with not enough relief to allow me to sleep well at night. I decided I needed to go ahead with the surgery.

The surgery

I did a lot of research, and found a surgeon in my area with a lot of experience doing the nissen wrap. He reviewed my case and said I was a great candidate for surgery.

My surgery took place this past Tuesday, August 12. I checked in to the hospital early in the morning, and was told the procedure would take around 4 hours. I was set up with an IV in my wrist and wheeled into the waiting area. My anesthesiologist came by to talk to me about my medical history, and I spoke with my surgeon and the staff that would be assisting with the operation. They confirmed my medical history, asked about previous operations I've had, and asked if I had any questions before we started. I was then wheeled into the OR, and transferred from the bed I was in to the operating table. After getting settled in there, I don't remember a thing until waking up in recovery.

Recovery

I woke up gradually from anesthesia, and do not recall any pain at all at this point - however, I did have to pee reeeeeaaaaallly bad! I asked the nurse for a bedpan, and tried to go but I wasn't able to. I was too worried about possibly wetting myself to be worried about anything else right then and there! :p

I relaxed in recovery for what seemed like 20 minutes, but was probably a little longer. The surgery only took a couple of hours, much faster than anticipated, and everything went very smoothly. I did feel a sensation of pressure around my abdomen, but I wasn't sure how much of that was from needing to use the bathroom, or if I felt like I needed to use the bathroom because of the pressure. My throat was very dry and scratchy from the breathing tube, and my mouth was very dry. Otherwise, I was groggy but not uncomfortable.

Within a short time I was wheeled up to my room, and was able to use the bathroom before getting settled into my bed. The core muscles you use to go to the restroom seem to be irritated by the surgery, so it was an exercise in patience to get it all out, but not painful.

Day one

The first day I was hooked up to an IV and a morphine drip. My body was in shock from the surgery and weak. The pain I felt on day one was mostly concentrated around my neck and shoulders, and likely due to the gas used to open up the abdomen during the surgery. I have four puncture sites which were sore to the touch, but no noticeable stomach pain at this point.

Day one I was only given water and ice chips. My mouth was very dry so I tried to eat ice regularly. I was still very unsure of my ability to swallow, and very cautious. I was aware of the sensation of the water traveling all the way down my throat, and once it hit the wrap location it was uncomfortable.

As the day wore on, I became more uncomfortable. Even with the morphine drip, the pain was climbing to about a 6 on a scale of 10. I'd say the worst of it was the first evening after surgery - I developed a bout of hiccups that lasted around 45 minutes. I tried breathing deeply and slowly, holding my breath, drinking water, but nothing would help them subside except more morphine. I had a couple more bouts of hiccups, but each was shorter in intensity and I was able to tolerate them better. They seemed to be triggered by drinking too much or too quickly, but the nurses told me that it's common to develop hiccups as a result of coming off the anesthesia regardless of the type of surgery.

Day two

I was not able to sleep for more than 30 minutes at a time, between the pain and nurses coming in to check vitals or administer medication. Waking up on day two my overall pain had increased. I developed an all-over body ache, and the pain in my chest was more intense. I was able to get up and walk around a bit more, which seemed to help speed the dissolution of the gas. Day two was definitely my most miserable day.

However, by day two I graduated from ice and water up to clear liquids, including jello! I was excited to have some broth, jello, and a popsicle for breakfast. Eating was a very slow process, but so enjoyable!

I had the same for lunch, and by dinner I was bumped up to creamy liquids, including pudding and cream of chicken soup!!!

Along with the body ache and chest/shoulder pain it was difficult to breathe in deeply. I had a respiratory therapist visit me, and left a spirometer to help me maintain lung capacity. I did my best to use this a few times every hour, and tried to walk the hallways at least twice.

By the end of day two I'd been taken off my IV and morphine drip, and switched to dilaudid pills for the pain relief. I was able to take them whole with no pain (they are very small at least) and I was also able to take my other regular medication whole, as long as I took them one at a time.

Day three

The morning of day three I had oatmeal, and it was the most wonderful thing in the world! I was released later that morning, and spent most of the day at home napping. It was wonderful to finally be able to sleep for more than an hour, uninterrupted, without a nurse or staff member coming in to check on me.

My pain now is much more diffuse and much less intense. I mostly feel a medium level of ache and soreness, but mostly am just generally weak. Most of the chest and shoulder pain has dissipated, and while my stomach is sore it's not too bad.

I'm careful getting up and laying down, and I try to walk around as much as I can. I have not tried lifting anything heavy yet, although I did successfully pick up my 9 lb cat without any pain or struggle. I'm not going to push my limits too much :)

My plan is to work remotely next week, which I think I will be able to manage. I'm still on pain meds around the clock, but I plan to take a break either later this evening or tomorrow morning to test my pain level and see if I can do without them.

I'll post updates through the remainder of my recovery, and if anyone has any questions I'm happy to answer them.

Overall I am so happy I've decided to do this. Even the first night after surgery, despite the pain, it was the first time in years I have been able to lie down flat without the contents of my stomach pouring up into my throat. I can already tell it's made a huge difference, and will finally provide an opportunity for the inflammation in my esophagus and stomach to heal.

I anticipate I may still have a few rough bumps along the way, but I will be cautious and take care of myself so that I can provide the best chance at healing possible!

Thanks! I wanted to say that this forum has been so helpful in preparing me for what I would experience. My doctor and nurses were impressed at how much I knew in terms of recovery and what to expect, and I'm glad I had my expectations set accordingly.

It was definitely a scary prospect going into it, and one of my nurses even said that she had been considering it but has been too scared to follow through.

If I hadn't known how the course of healing would occur, or that I can expect the swelling to continue over the next few weeks, or just how patient I will need to be for full healing I may have been very frustrated by this point. But, I feel that reading everyone's experiences here really gave me a realistic understanding of what to expect.

I'm much more comfortable at home today than I was even yesterday, and I'm hoping I can taper off my pain meds either today or tomorrow, and move to just Tylenol by the weekend.

Hi Brianala,

I want to consider to do nissen fundoplication but I have to see Gastroenterologist in September. I have been with Gerd 2 years now and I tried all PPI and none of them worked for me.

Can I ask you, did you had this symptoms with the GERD: Wind, bloating, excessive burping, Excessive saliva.

Do you feel that you want to burp? I mean we mostly don't burp as we don't think about it, if we do than we get addicted to it.

Also for autonomic dysfunction, do you you mean like you feel dizzy alot, like having a bath as laying down and when you get up like in 20 mins and you feel very dizzy. I have dizzy problem because of Gerd as it got worse for me.

ninjakiller1 said...

Can I ask you, did you had this symptoms with the GERD: Wind, bloating, excessive burping, Excessive saliva.

Do you feel that you want to burp? I mean we mostly don't burp as we don't think about it, if we do than we get addicted to it.

Also for autonomic dysfunction, do you you mean like you feel dizzy alot, like having a bath as laying down and when you get up like in 20 mins and you feel very dizzy. I have dizzy problem because of Gerd as it got worse for me.

I actually did not have those symptoms. In my case, the primary symptoms I dealt with were severe heartburn, chest and stomach pain, and regurgitation. I really couldn't burp - I would get the sensation, but if I tried to burp it would just bring up stomach acid and burn my throat, so I rarely burped if I could help it.

Now, after the surgery, I can burp like a normal person!

I've been diagnosed with several things under the umbrella of autonomic dysfunction: Neurocardiogenic Syncope, Inappropriate Sinus Tachycardia, Postural Orthostatic Tachycardia Syndrome, Orthostatic Hypotension, and Mitral Valve Prolapse. There's a lot to it, but basically the things that my body is supposed to control automatically (respiration, heart rate, blood pressure, digestion, temperature control, etc.) don't work the way they are supposed to. Yes, I do feel dizzy quite often, and I have a number of other symptoms. Dinet.org has a lot of good information on Dysautonomia if you're looking for further information!

ldrunner said...
I had the same, I went almost a week. Prune juice sorted me out nicely.

It's worth eating roughage (when you are able) like All Bran and apples etc, and using the prune juice as I found making everything go through smoothly eased my recovery considerably. Often I had reflux and muscle pain in my core and abs that went after a movement.

9 months later I'm still on the All Bran every morning. Pour the milk on and let is soak for 10 minutes so it turns to liquid.

This is very encouraging to hear! I'm a little less worried now, I know it will happen when it happens, but it's good to know I'm not alone :p

Day six

Today is day six, and I'm about the same as yesterday. I did manage to get out of the house for a little bit earlier, but after a few minutes I was worn out completely. I tried to cut down my pain pills yesterday, but that was not the best idea. I'll continue with my full dose for another couple of days, I think, before trying again.

I'm scheduled to work remotely next week, but I don't think I'll be able to stay alert for a full day's work for at least a couple more days. I'm going to put in a few hours on Monday and Tuesday, and try for full coverage by Wednesday. My pain is manageable with the medication, but the medication keeps me so tired and a bit too loopy to focus well.

GC1pink said...
Hi,

I'm so glad that you're doing so well, and on the road to recovery. May I ask what dysmotility you had and if you had a partial fundoplication.

I'm enjoying reading your diary and seeing your progress!! Keep us informed, and feel better soon.

My dysmotility is not too severe, here are my manometry results:

LES pressure 39
UES pressure 124 (Hypertensive)
92% peristaltic, 8% failed swallows
26% double peaked

I believe the intention was to do a full wrap, but I forgot to ask after if he was able to a full or partial. Either way, I'm able to swallow as well as I was before. I'm curious to see how things go over the next week, since I know swelling can continue into week two.

Day seven

I slept a little better last night. I'm attempting to go off the Dilaudid prescribed by the hospital and switch to Tylenol for my pain. The pain itself is more manageable now, it seems. Less shoulder pain, and the incision site pain is sore to the touch but not overly sensitive. Internally, I still feel like I was punched in the solar plexus.

I'm not a fan of the side effects of opiate pain medication. I'm tired of being loopy and half asleep most of the time. I'm hoping there isn't a great deal of withdrawal, considering I've been on them about a week now.

I spoke to my surgeon's nurse today and she advised me to stay on a full liquid diet, or anything about the consistency of applesauce, until my next appointment on the 27th.

I feel that the swelling in my wrap is definitely increasing, as it's a little more difficult to swallow today than it was yesterday. Also, I don't have any sensations of hunger whatsoever today. It wasn't until about an hour ago that I realized I hadn't eaten anything at all today, which is unusual for me. I've been hungry first thing each morning until now.

I did manage to get out of the house today. I drove myself to the store and walked around for a bit, and while I was incredibly slow moving, I think I managed ok. I wouldn't want to be putting in a full day at work today, that's for sure. I spoke with my work and they told me to take the rest of this week off, and not to worry about working remotely. I think I am going to take them up on the offer.

The primary issue I think I will have this week is not pain but fatigue. Everything I do wears me out so much. I'm sure it's going to be a struggle to maintain nourishment this week. I'm going to change the alarms on my phone from "Take your pain meds" to "eat something calorie dense and nutritious!"

I verified that I did indeed have a full wrap performed, too. I'm not sure if the difficulty swallowing I am having today is just normal swelling, or due to the underlying motility issues I had, but hopefully I'll see some relief in another week or so.

Continuing to keep on keepin' on!

Brianala said...

The primary issue I think I will have this week is not pain but fatigue. Everything I do wears me out so much. I'm sure it's going to be a struggle to maintain nourishment this week. I'm going to change the alarms on my phone from "Take your pain meds" to "eat something calorie dense and nutritious!"

Calories are difficult. I didn't put much thought into it and just went for essentials like protein and vitamins. After the first week when I lost 12kg I realised I'd inadvertently put myself on the Atkins diet :) The problem is you can eat so little that you find yourself staying away from carbs due to their bulk. Definitely just focus on what goes down easiest though. People have told me I should have gone on the weight gain drinks but I don't know if that's a good idea or not as I've no idea of the effect these have on your stomach.

If I could do it all again I'd definitely take things easier than I did. Move around if it feels ok and go for little walks but definitely don't try and train or exert yourself for a long, long time. I was off work for 3 weeks but for me personally that wasn't enough. I was pretty weak when I went back.

The previous post is bang on. The side effects change - and they are weird. I was told on this board to ignore them and I thought "that's bad advice". I was wrong, it was good advice. Some days you'll feel strange movements in your esophagus, other days you'll feel like your actual throat is closed, other days you'll be 100% convinced your wrap is undone (I can guarantee this). I know it's hard but just take it easy and ignore them all. You'll also feel pulls in your torso that feel like you've damaged your wrap. Ignore these too, it's just scar tissue.

It's worth it in the end :)

Thank you so much for your informative daily posts. My Nissen is scheduled for Sept 5.

Hi everyone,

I had the nissen fundoplication and also hernia repair at the same time, the first day I was quite sleepy but couldnt sleep much, the second day I felt in a lot of pain, and felt quite nauseus, i was given an anti-emetic and this worked great.

I came home the next day, but still in a lot of pain, so was on liquid tramadol and paracetomol, which helped with the pain,

Im now two weeks post op, im having on average a bowl of soup, and small ice cream and one hot drink per day, im drinking plenty of water.

I also have the problem with the bowels, I have been twice since the surgery, but I am sure it will come back to normal.. I was advised to stay on liquid diet for six weeks, but I think that depends on your surgeon

The thing I was suprrised about was after surgery I had no heartburn at all, and can lay on my back now which is a good thing because after the surgery that is all i could do.

I feel ok in myself, but I will not over excerte myself, as I had the two things done whilst in surgery, so have been told to take it easy for at least six weeks. 

I feel full quite quickly, I have the soup slowly, but once I feel full I then stop.

I feel at the moment it was the best thing for me to have the surgery.

Hope this helps

I dont feel nauseous, i just feel full when i have had so little soup or ice cream , I can only manage one hot drink per day aswel and only when it has cooled down too.

I cannot actually burp at the present time... I get sort of hiccups

Has anyone else experienced a numbness pins and needles feeling in the thigh , those of you who have had the mesh for a hernia.

Brianala, so glad to hear of positive progress. I'm seriously thinking that this surgery is my only hope to get my life back.

I won't go into all the details but I've exhausted every medication and continue to get worse. Sick everyday with nausea, shortness of breath, heartburn despite being on PPI's which just made it all worse.

I will be following your progress. I 'fired' my gastro doctor because he never even mentioned 'fixing' my root cause. Just wants to pump me full of useless PPI's. I will be consulting with two other gastroenterologists in late September and October and will not stop until I find a doctor that can FIX the root cause of my misery. I just want me LIFE BACK!

I will be following your progress and can learn a lot from what you report, so THANK YOU for being here with your 'fellow sufferers'. I also followed Stephaniejean who had a successful surgery as well over a year ago ... further encouragement.

Keep taking good care of YOU and I will be looking forward to reading more -- THANKS!

Hi Brianala,

Welcome to the Wrapped Club! Better late than never! I enjoyed reading your recovery journal. It sounds as if you've got a great attitude (the key to a positive experience) and are making excellent progress.

Wrap swelling is no fun. I remember seeing my surgeon on Day 6 post-op, and he told me that my swelling would be getting worse before it got better. Boy, was he ever right. I can identify with everything you're experiencing. I remember feeling the water sitting in my esophagus, and gradually dripping into my esophagus.

Just makes sure to take small bites and chew, chew, chew. If you're not lactose intolerant, you might want to try egg custard. You can make your own easily, it's tasty, highly nutritions, and very smooth and easy to eat. It's very easy on your esophagus and wrap as well. Here's the recipe I use:

Egg Custard:
8 eggs
5 c. milk
1/2 tsp. salt
1 c. sugar
1 tbsp. vanilla
a little ground nutmeg

Bake in a pan of water/water bath
@375 for 1 hour
You'll know it's done when a knife comes out clean
(no milky substance--it'll be a bit wet).
You can also tell by how jiggly it is!

Be sure to grease/spray the pan before pouring in the custard mix.

Thanks again for sharing your experience!
Happy healing!
Denise{/b]