HealingWell
Search Close Search
☰

Headed for anti-reflux surgery

Support Forums
>
GERD & Acid Reflux
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 2/2/2015 9:36 PM (GMT 0)
Hello,

This is my first post so pardon for rather long post. have read as much as I could in one day ;).

I was diagnosed with GERD + Hiatal Hernia after constant dry cough for 4 months. Since it was dry cough with fatigue, my PCP sent me to pulmonary specialist to see if there was anything wrong with my lung function (I was still recovering from 3 months of acute sinusitis at that time). I had usual PFT which came back abnormal in addition to about half of normal lung volume. So the lung doctor tried several inhalers and several combinations of prednisone. None had any effect. I was not able to lie down at night which means I spent those 4 months on a recliner at night to the point that the recliner is amost worn out. Finally the good doctor administered Barium X-ray and Barium swallow test which is when the radiologist was able to see acid refluxing almost to the top by esophagus. Barium tablet (13 mm) hung for 10 seconds before I was able to swallow it and I still didn't believe it had gone down because it left irritation from hanging in my throat. For a few years I have had problem of flap not closing in time to cover wind pipe so food/ drink goes down the wrong way sometimes. During all this time, I slowly started feeling burning in my stomach. After the Barium test, lung doctor told me to see my GI. I have a great GI doctor!!! He performed EGD, found lesions and scarring in 5 places on esophagus and dilated upper part of my esophagus and also put me on PPI. That helped a lot - my cough stopped and I was able to eat...

Unfortunately , that seems to be undone during an emergency knee surgery I had in December. Because I was under general anesthesia, they had inserted breathing tube down my throat. When I woke up in recovery room, I could not breathe and my SpO2 level started dropping. They immediately put oxygen mask but the level was hovering around (supposedly) dangerous level (between 70-80) for about 3 hours. Naturally I was kept back under observation for a couple of days with nasal oxygen tube. The performed all kinds of tests to make sure no major organ was damaged before letting me go. Then exactly one month later during my routine annual physical, I had my flu shot (very late this year because of everything going on) and as luck would have it, I got flu the next day! mad

Since I came back from hospital, I have got my dry cough slowly back and increasing. There is constant burning in my esophagus and stomach. I cannot sleep, can't talk much, throw up acid from time to time. As a result my GI specialist wants me to have surgery as last resort.

Question is - I know these days laparoscopy is preferred over open surgery but I am more inclined to open surgery if there are more chances of second surgery needed in case of laparoscopy. what are suggestions/ thoughts? Are there chances of need for second surgery even after open surgery? I don't work any more, so recovery time is not a deciding factor (or is it still?)

Thanks in advance
Elizabeth
-------------------------------------------------
Multiple Sclerosis (no injection/ oral medicine works for me)
Osteopenia (with family history of osteoporosis)
GERD + hiatal hernia
deviated septum in nose
frequent upper respiratory infection
-------------------------------------------------
Usual diet - ovo-lacto-vegetrian
Extremely rare consumption of coffee or carbonated drinks
Never ever used tobacco in any form or alcohol or rec. drugs
Need to shed about 25-30 lbs.

Post Edited (Eliza_T) : 2/3/2015 11:56:04 AM (GMT-7)

Posted 2/2/2015 10:58 PM (GMT 0)
Hi Elizabeth,

Without having to many hard facts I do think laparoscopy is the better choice as the outcome is similar in the studies I have seen. Choose your surgeon wisely... an experienced surgeon is probably what makes the difference in the most cases.

I wish you all the best whatever solution you choose.

Daniel
Posted 2/2/2015 11:19 PM (GMT 0)
Thanks, Daniel. Thankfully my GI doctor has referred me to a surgeon who has good reputation. I am meeting the surgeon on Thursday. So I will make a note of your point about experience for the questions to ask. Do you also think that it is a good idea to compile a list of questions in my mind to ask the surgeon? Since none of MS medications has worked for me, my health has become quite fragile and the list of medicines I can't tolerate is ever-increasing.
Posted 2/3/2015 11:29 AM (GMT 0)
Hello Eliza...and welcome to the forum!

The laparoscopic method is, by far, the most preferred way to perform the fundoplication procedure. Since the trauma to your body is minimized via laparoscopy, the recovery time is shorter and you have considerably less pain.

The skill of your surgeon is really the biggest factor, here. Your thoracic surgeon should have several hundred laparoscopic fundoplication procedures under his/her belt. I would inquire as to his/her success and "re-do rate" when meeting them.

At face value, the risks of an open procedure are way too high when compared to a laparoscopy. If you have a competent surgeon, there should be no reason to believe you'll need to have a second fundoplication surgery unless complications arise later (or you've had an incompetent surgeon to begin with).

Be well and take care!
-TonyG-
Posted 2/3/2015 4:12 PM (GMT 0)
Thank you, TonyG!

So it looks like experience of surgeon is really a very important key in the process. I will definitely try to get that information so we can make a well-thought-out decision.

I do understand that open procedure will carry far more risks and higher recovery time (my Dad had to have his gall bladder removed in April at age 81 - the surgery was planned as laparoscopy but during the procedure, the surgeon had to resort to open surygery; may be due to Dad's age - I don't know; and it is only know that he says he feels normal again! Of course, my Mom played a huge role in getting him back on his feet and still does). When you say 'if you have a competent surgeon, there should be no reason to believe you'll need to have a second fundoplication surgery unless complications arise later' is it in respect to open procedure or both?

And oh - congratulations on successful Nissen and good recovery! Keep it like that, friend. Best wishes for that.

Thanks again!
Eliza
Posted 2/3/2015 7:30 PM (GMT 0)
For obvious, only a surgeon that has performed the Fundoplication procedure, open or otherwise, should be considered. I really would rather a rookie NOT go near my insides with sharp instruments to perform an operation they haven't routinely performed for many years rooting around inside me.

That said, laparoscopy takes a greater amount of skill and dexterity and as such you should really look for a surgeon that is adept at not only advanced laparoscopic surgical procedures, but one that has specific training and significant experience with the Nissen procedure. Additionally, this surgeon should be a Thoracic Surgeon, as they are specialists that have advanced education in the anatomy of this region of the body.

Hope that helps!
-TonyG-
Posted 2/5/2015 3:37 AM (GMT 0)
Hi Elizabeth, I don't know if you read my post of just having had a large Paraesophageal Hernia repaired December 30. I might have been more hesitant about doing it if I knew the surgeon was going to open me up. Mine was so bad he had to hold on to my liver for a very long time and broke a blood vessel which caused an emergency and I had to be opened up. I was in the hospital for a week in ICU. SO as of today which is 5 weeks since my surgery I have lost 36 pounds. Have been on a liquid diet for most of this time. Craving protein which the Doctor said drink Boost. I have to eat short snacks but I don't feel hungry. This is almost like Lap Band Surgery I guess. Would I do it again if I knew they were going to open me up? Maybe not but I think I've been thru the tough part of this hopefully. Didn't think I would ever see 2 waist sizes and 201 pounds again. Good luck
Posted 2/5/2015 5:12 AM (GMT 0)
Hi TonyG,

Yes, I completely understand your point and that is probably one of the reason why I would rather go under the knife. If I am my father's daughter tongue , why not just start with open surgery!!! I don't mean to say it requires lesser experienced surgeon but from everything I have read on the forum and you guys, skill and experience seem to be really critical when it comes to laparoscopic surgery...

I am shortly posting a list of questions I have prepared.

Thank a bunch!
Eliza
Posted 2/5/2015 5:29 AM (GMT 0)
Hi fbr,

I have most certainly read your post and really feel for you for having to go through such an ordeal. Hopefully breaking breaking the blood vessel was an unfortunate accident and doesn't reflect on your surgeon's skill... You must be very tough - kudos for going through all this and your post still doesn't sound like complaint or self-pity!! I hope you are taking it easy and recover well! Paraesophageal Hernia is not a good news to begin with.

Fortunately my hiatal hernia is not huge (at least as of 09/2014).

As for losing weight, I will take it... because I need to shed some 25-30 lbs also but I had planned on doing it in a more healthy way (whatever that means). Unfortunately for me, for over 8 years I am dealing with MS with NO medication of any sorts working for me - injections, infusion, new oral drugs; my body develops a reaction to each and every medicine I have tried which means I have to deal with a relapse on a regular basis (like clockwork, I get it every other year and usually lasts for a year and half...) So it has completely weakened my whole right side and dizziness is my constant companion. All this also means I have a really compromised immune system and hence catch every infection at the drop of hat.

So I worried about a recent knee scopy followed by flu and heading for funduplication with compromised immune system.

On brighter side, I will hopefully get rid of constant coughing which really tires me and gives me pain and cramps plus, the constant burning in my stomach and esophagus will also leave me alone.

Thanks and heal well!
Elizabeth.
Posted 2/5/2015 5:33 AM (GMT 0)
Here are the questions I have thought about to ask the surgeon when we meet him tomorrow. Please feel free to add/ remove/ correct. Thanks in advance.

- Is the surgery only option?
- What kind of surgery will be performed? Laparoscopic or open?
- What are pros and cons of both?
- What are chances of repeat surgery in either case? Are they different for one vs other?
- After laparoscopic surgery, burping, belching and throwing are difficult or impossible ? I have chronic tendency to throw up bile. What are my options?
- What kind of lifestyle changes are required post-surgery?
- Due to MS, it is difficult for me to lead active lifestyle. How do I lose weight in healthy way?
- Recently after right knee arthroscopy, I had breathing issues reaulting in SpO2 level less than 80 for over 2 hours. I had similar experience several years ago. That is a concern for me.
- What kind of fundoplication surgery you have performed most? How many?
- What is approximate success rate?
- How many patients have needed second surgery?

Post Edited (Eliza_T) : 2/4/2015 10:36:29 PM (GMT-7)

Posted 2/5/2015 9:45 AM (GMT 0)
Hi Eliza,

These are good questions. A couple things to note,

-Regardless of whether it's open or laparoscopic, you will not be able to vomit after having the fundoplication surgery. The wrap is meant to keep stomach contents, bile, etc OUT of your esophagus and as such it will be VERY difficult to vomit, if possible at all.
-For the first year following surgery, burping/belching will be close to impossible. Even now, at almost two years post-op, I can barely get out a squeak of air. I certainly cannot burp like I used to. You need to make some adjustments to the way you eat and what you eat, and you may get bloated from time-to-time.
-If you sign on for the surgery, I would make specific notes with questions for your anesthesiologist. As they'll be the ones responsible for maintenance of your airway and breathing, your SpO2 question would be a good one for them.

Keep us apprised of your progress!
-TonyG-
Posted 2/5/2015 4:22 PM (GMT 0)
Thanks so much, TonyG! I am really glad to have joined the forum. These days nobody 'really cares' for the other like you guys do and I must thank you for very good suggestions and sharing your experiences with a total stranger purely to help!

Hmmm... throwing up is a problem sad I spent first few years of my life in the tropics and could never handle hot and humid climate there. Getting the bile out of my system would make things bearable for me; otherwise I would be in bed with bad headache and unable to eat anything. When I got back home, unfortunately, I carried that with me. I can't even be in sun for more than 10-15 mins. and living in TN, we get plentiful of that mad

Burping/ belching hopefully I will be able to manage (I know it sounds crazy to say this without having experienced what it is like not to) but I heard things like Beano help.

I will most certainly bring up the question of SpO2 for the anesthetist.

Will keep you guys posted

Sincere thanks!
Eliza.
Posted 2/6/2015 6:22 PM (GMT 0)
Hello Everyone,

Met with the surgeon yesterday and considering that I have MS for over 8 years and I dry-cough so much due to GERD, he was rather skeptic about the usefulness of surgery. He doesn't deny that I have severe reflux but he said cough won't go away after surgery. He was also concerned that I had so much burning in my stomach and esophagus in spite of being on PPI.

He had me undergo Esophageal manometry today and is going to see me next Thursday after we have results from the test. The test wasn't pleasant at all! I had lot of nose-bleed and also spat out some blood after the catheter was removed.

Has any one else experienced that dry cough does not go away after Fundoplication? What about burning feeling?

What I liked was - he was at least honest in his first impression about what the surgery would do and what it won't! Needless to say, we did not come to a point where we discussed any of the questions I had listed.

Thanks guys,
Eliza
Posted 2/14/2015 7:59 AM (GMT 0)
Surprised to see my cough getting better after manometry! Got the results - out of 10 sips, esophagus was able to move 8 absolutely normally. Since the cough it getting better and manometry is encouraging, my surgeon is ready to perform the surgery on my - in fact he wanted to perform it on Tuesday (02/24). However, now that cough is better and from everyone's experience on the forum about diet changes post-op, we decided to give us a month and so we have it scheduled for 03/24. The main reason is, I want to get used to liquid diet even before the surgery. Hopefully, it will also help me to shed a few pounds. So tomorrow we are going to get a cold-press juicer. We already have blender and soup-maker. My husband is also going to try juicing - just to get better health.

This one month will also give me time to build up some strength after knee surgery in December and entire January lost in flu. I wasn't sure my body was ready for another, especially life-altering surgery on 02/24.

about the questions I had prepared, got answers ro most of them -

- Is the surgery only option?
Yes, from all tests and given the fact that I am not taking PPI for past one week and it has made not difference whether i take or not, the surgeon said it is all the more reason to go for the surgery. My GI doctor and PCP also have the same opinion.

- What kind of surgery will be performed? Laparoscopic or open?
Of course, as expected laparoscopic.

- What are pros and cons of both?
Per my surgeon laparoscopic is easier because it gives him access to the entire GI system - all he needs is small cuts while with open, he will only be cutting what is required and for anything more, he will have to cut more. Risk of infection, duration of hospital stay and recovery time are lot ore important to him medically (he did say that they have to be always prepared for open surgery in case something does not go as planned during laparoscopy)

- What are chances of repeat surgery in either case? Are they different for one vs other?
Chances of repeat surgery are very individual and no, they do not depend on whether the surgery was laparoscopic or open.

- After laparoscopic surgery, burping, belching and throwing are difficult or impossible ? I have chronic tendency to throw up bile. What are my options?
None of these are impossible but difficult. As for chronic bile, unfortunately, between me and my GI we will have to figure out something.

- What kind of lifestyle changes are required post-surgery?
Nothing different from what you all have noted.

- Due to MS, it is difficult for me to lead active lifestyle. How do I lose weight in healthy way?
Immediately post-op, I might lose a few pounds any way. Plus juicing and trying to be as active as I can should help. I am not at all a candidate for lap-band according to him. I am just need about 25 pounds to lose.

- Recently after right knee arthroscopy, I had breathing issues reaulting in SpO2 level less than 80 for over 2 hours. I had similar experience several years ago. That is a concern for me.
Yes, TonyG, as you pointed out, I will bring it to attention of anesthetist.

- What kind of fundoplication surgery you have performed most? How many?
Laparoscopic surgery is the way to go with rare complication where he had to resort to open. He has more than 200 under his belt.

- What is approximate success rate?
about 95%. On rare occasion, he has undone the wrap, when say the patient was unable to even swallow water.

- How many patients have needed second surgery?
Didn't ask this question to him - I know it is about my health but somehow I couldn't bring myself to ask him about this.
Posted 2/14/2015 3:23 PM (GMT 0)
Since the knee surgery was recent, you could ask that doctor for his operative notes and try to get the notes on what you were given for anesthesia. That might give the next anesthesiologist some idea what NOT to give you. I'm post-polio and got some great information from Googling my condition and anesthesia. I'm also sulfite intolerant and have to make sure that preservative isn't in any of my meds. During my surgery I was given too much pain med and slept an extra 2 hours.

Just my opinion, but I wouldn't be "juicing," at least not for any length of time. I did prepare, in advance of my Toupet (partial Nissen), a bunch of my own juice and broth, also some baby food-soft foods and froze them for use until I was well enough to cook a little. So many of those commercial products are full of additives, colors, preservatives ..... But I don't "juice" on a regular basis. Look up some scientific studies, if you can find any. Forums are just opinions of untrained people. (OK, some of the people are smart, but if we were trained, we'd be writing for scientific journals.) From what I've read from "reliable" sources, "juicing" doesn't give you enough fiber and protein.

After this surgery you'll probably be on pain meds for a while. Ask for a liquid laxative because your liquid diet won't have enough fiber in it and pain meds put the gut to sleep. You don't want to be putting any extra pressure on your abdomen from constipation.

Ask if getting the gallbladder removed would be a good idea. It's quite often done during the Nissen surgery.

You probably won't be able to vomit. I can't after 5 years. During the swelling phase a few days to a few weeks post-op, you might not be able to burp either. Look up "gassy foods," and avoid them until you can burp. Don't put them in your juices.

My recipe for losing weight is to avoid bread and related things. I lost 50 lbs without doing anything else. It took a little over 2 years. I just don't overindulge in bread now. Keep the toaster in the cupboard.

But don't start trying to lose weight right after surgery! Wait until you are on a regular diet and feeling well.
Posted 3/26/2015 4:50 PM (GMT 0)
I had my Nissen on 03/24 as planned and I was discharged after 24 hours - so I am home trying to recover. Last night the pain was excruciating and I also threw up a little. So we called the hospital. Fortunately, my surgeon was on-call - he told me to take more pain medication, use a long wedge to sleep on and cut back on water - he said drinking too much would cause bloating and put pressure on sutures increasing pain level. He also advised to take Gas-X. I was on pain level of 17-18 over 10!!! It's very rare that I am tearful due to physical pain. Last night was definitely one such incidence!

From today, I can started pureed food along. I can also take shower in afternoon and change into a soft nightgown.

FOrtunately, everything went well as far as anesthesia was concerned and hospital staff was great!

So now that it is done, one day at a time...

How long before you can expect to feel normal again?

Thanks everyone for your great help!
Posted 3/27/2015 2:18 PM (GMT 0)
Hi Eliza,

Welcome to the yeah yeah yeah Wrap Club! yeah yeah yeah yeah Like you, I joined the forum several weeks before my surgery, and received lots of support and information.

Here is a link to my early recovery journal:
www.healingwell.com/community/default.aspx?f=45&m=2183443 It'll give you an idea of what early recovery looked like for one person.

I did find that I was more comfortable sleeping in an elevated position during recovery. Pain medication is key in the beginning, and don't let the pain get ahead of the medication. Even when you feel comfortable to switch to liquid Tylenol or something similar, you'll want to take the stronger medication at bedtime, since pain seems to increase when things are quiet.

The first two weeks are by far the toughest, so hang in there. Stay away from carbonated beverages, iced drinks, and straws. Iced drinks can cause painful spasms, carbonation and straws add to bloating.

If you can get up and walk around a bit whenever you go to the bathroom, it can help move the gas along. I had terrible shoulder pain, which was the worst for me. Walking definitely helped relieve that.

You also fill up very quickly. I could only eat a quarter to a third cup without feeling stuffed. This is due to swelling of the stomach fundus, giving the brain the message that you're full. This subsides gradually over the next couple months.

During the first two weeks the wrap becomes increasingly more swollen, so don't panic. My surgeon told me that my swallowing would get worse before it got better. You can also get a painful "lump" sensation, which is a result of this swelling. Hang in there...once past peak swelling, you're on the road to recovery.

This recovery takes six months for most of the healing and a year for the rest. But don't panic...you'll feel better before that. It's just that you can't expect to be totally healed right away. Often surgeons give the impression that after a couple of weeks you'll be back to your normal self. This isn't true.

You'll need to always chew your food more fully. Chew, chew, chew, anything you eat until it's a liquid consistency. You'll never be able to swallow big chunks of unchewed food now. But on the bright side, chewing is the best part of eating, and it aids in digestion. Everyone should chew their food like that!

Glad you've joined the forum. It's a great place to receive information and support as you recover!

Happy healing,
Denise
✚ New Topic ✚ Reply