Peg's Troupet and Hernia Repair Journal

May 1,2015 I had surgery to correct a large hiatal hernia and a troupet fundiplication. This is Day 4 of my recovery and so far all has gone well. Surgery lasted 5 hours and was done laparoscopically. I was in recovery for one hour and in my room until late afternoon the next day when I was discharged. I was on a morphine drip to manage pain for the first few hours but that was stopped earlier than expected since the initial pain subsided very quickly. Pre-op, the surgeon said about one third of my stomach was in my chest cavity but in surgery he found that almost all of it was in the chest and because it was difficult to dislodge, he believes it was there for quite a while. There was quite a lot of damage to my diaphragm that took time to repair. (He later explained that the area where the esophagus passes through the diaphragm is usually an opening with a radius of about 1 to 1.5 inches. Mine was more an oblong 6inches by 1 inch. That shocked me and still does).Using a temporary dissolving mesh as a scaffold he rebuilt my diaphragm. Then he did a troupet (or 270) fundo.
The next morning the doctor removed the nasogastric tube that was down my nose during surgery (really not so bad as it might seem), I passed the swallow test - no leaks anywhere- so they gave me a breakfast of tea, broth and juice and started discharge. They didn't remove the surgical catheter until just before discharge so I wasn't able to walk while in the hospital as I planned to.
My shoulders have not been painful like I expected but the middle of my upper back just below my neck has been. The doctor said it's referred pain from the diaphragm and will go away in a few days. So far, Day 4, it's still there.
At first it was hard to breathe deeply but that's getting much better. And the best of all is that right from the beginning I could belch! What a great feeling! I've been doing it a lot!
I've had no problems swallowing but have not tried to rush anything. It's juice, coffee, broth and a protein drink in small amounts throughout the day. The biggest thing for me now is the fatigue. I get very tired and fall asleep often. Again, I'm not in any rush. This was a major surgery and it will take time to recover.
Before the surgery, I wrote about my anxiety and can now say that I worried too much. There is some pain but not much and it dissipates quickly. I'm glad that I went ahead even though I know it will take a long while to fully heal.

I was amazed that I could have virtually my whole stomach in my chest and not know something was so wrong! Or that none of my other doctors ever guessed. But then I suppose it isn't something they would expect or go looking for. The first real clue was when my cardiologist saw "something" behind my heart on my last stress test. We'll, I've now been told that my tum was up there for a long while so I expect it will take some time for it to reacquaint itself with its old neighborhood. I hope all the other organs are glad it's back and that they all get along well.
You can bet I'm paying lots of attention to your story! I did wince at the trocars pains you relayed and glad they subsided. Thx for sharing.
Peg

Day 7 Post Nissen. I'm feeling more alert. The only pain I feel continues to be an area on my upper back just below the neck and on both sides of my spine. But the pain is diminishing and for a few hours yesterday it was gone entirely. I haven't taken pain meds in 4 days although I have crushed a 5mg ambien to help me fall asleep at night. As much as I do nap throughout the day, falling to sleep at night has been a small problem. Once asleep though, I sleep well.
I have no absolutely no problems swallowing so far and can see how one could get careless and move ahead too fast. For now I'm still on full liquids but have added thinned mashed potatoes as my favorite dinner and cream of wheat for breakfast. I eat small amounts throughout the day and am keeping a food diary mostly to try to track calories. Since coming home I've had a protein shake every day so I know I'm getting some nutrition. The past two days I've felt like I should eat more - no hunger pangs or anything- maybe I'm just missing food! Anyway, that's when I added the mashed potatoes and they seem to have done the trick. Yesterday my stomach made its first noise- a few gurgles- so I know things are going on down there. I've taken Miralax every other day to try to counteract the constipating effects of some of the drugs I got during surgery. So far, nothing happening there but I'm not concerned. I have gotten bloated, usually in the evening so I try moving around and that seems to help. I've been belching since surgery and passing gas is no problem. Since I have a little more energy I will try taking a few walks since that has been highly recommended by so many on this forum.
The first few days it was hard to take a deep breath but that cleared up around Day 5. Yesterday I started an occasional dry cough that I'll be keeping an eye on.
I stopped Nexium entirely and can't tell the difference so I'm delighted about that. My incisions are starting to itch a little and the steri-strips are starting to show wear and tear from the shower. My surgeon said he'd take them off at our post op appt a week from today but I'm not sure all of them will make it that long.
It's been the longest week to fly by like a rocket, if you know what I mean. I'm so happy to have the surgery behind me and am amazed with the speed From surgery suite to home, virtually pain free and alert. This week has been just the first baby step with much more healing ahead but I couldn't have had a better first week. Knock wood (I'm tapping my head) I can escape any serious complications.
For anyone considering this surgery, do your work and learn what you can in order to make your best choices. If you've found a good surgeon, move ahead. Don't let apprehension stop you!
Peg

Hey, Peg - Sounds like things are going really well for you. Hurrah!

Go slow; you have lots of healing time ahead. Sounds like your throat hasn't swollen yet; it probably will. I'm surprised you've quit your pain meds. If you feel like you need them later on; take some. Just don't drive...

Ask the Doc about relief for the itchy incisions. I'm using vaseline twice a day, but you shouldn't put anything on yours until the Dr. ok's it (danger of possible infection) Maybe a little oral Benadryl? Anyway, I always got itch-relief when I showered. Felt so good!

Napping is ok if you feel like it. I find if I don't by evening no body can stand to be around me, and cooking is almost impossible. Ergo, I nap! Don't always sleep at that time; just need to be on my back to quiet the constant soreness that becomes pain if I over-do.

An uneventful recovery sounds wonderful. Wish mine had started out so easily. But it's getting better for me. Mostly good days with a rough one here and there. All in all not too bad! I'm in Week 12 now, and a ways to go yet, so I understand.

Don't Worry; Be Happy! Ingrid

Hi Peg,
I had the same - at about the same time as you! I took me until about week 10 for things to settle down. I didn't end up with dumping syndrome - I had IBS systems - had constipation then diarrhea. If you are medication free - then your body will be adjusting to eating normally again - and digesting food properly again. I am still doing pro-botic drinks (yakult) every day - as I think my 'good' bacteria were no existent after PPI's and high dose ranitidine. All good now
Good to see you recovering well!

DAY 21. Three weeks since surgery. No problems swallowing. No pain, except upper back once in a while, especially when I'm tired. A few episodes of diarrhea so I'm still being careful to eat small meals of mostly soft foods, although I'm also selecting from a wider menu. Fish and chicken are good. I tried a salad and found the lettuce a little too stringy for comfort so I abandoned it. I tried one bite of a sandwich before I realized that a "bite" is an inexact measure and more than I take when I'm cutting food into pieces. So I deconstructed the sandwich, tossed out the bread and cut the meat into tiny bits that I chewed well. I saw my surgeon earlier in the week and he said we will meet again in 3 months. He does not expect to order any post diagnostic tests until, perhaps, at the one year mark an EGD. I was pleased with that.
Next week I see my GP and will be interested in what she decides about my regular prescriptions. She told me to stop taking everything right after surgery since the surgeon restricted swallowing pills. I'm sure I will be able to handle swallowing small pills now but some of my RX's are LARGE uncrushable tablets that I'd rather not try to swallow. Maybe she'll want me to chop them into smaller bits. That I think I could handle.
Hard to think its only been three weeks. Recovery has gone very well so far. Energy is coming back. Feeling good.
Peg

TWO MONTHS AFTER SURGERY.
Recovery could hardly be smoother. I have no pain (and never had very much to start with),can eat anything I want to and I can now bend over without feeling like I might vomit or pass-out! I stopped taking Nexium the day before surgery and haven't missed it at all. I do still get tired and sometimes I have a momentary pause when swallowing something but it only takes a few seconds' wait before everything gets to moving along as it should. I have less appetite than I used to and have been good about avoiding fats and way too many carbs. Eating a sandwich can be a little hard but steak, pasta, pizza are all fine. One of my incisions is still healing but the other four are little more than pink bumps. The biggest challenge I've had was taking my meds. At first I crushed the several pills I take and mixed them in juice. That worked out after a fashion but, truth be told, some tasted really terrible no matter what I used to mask the taste. A month ago I started swallowing the smaller pills and splitting the larger ones in half. That worked well so two weeks ago I started swallowing the large ones whole and they went down fine. It takes me several swallows, one pill at a time while pausing in between to get them all down but it works and I'm happy.
In the weeks leading to my surgery date, I had many doubts and apprehensions about the surgery and how I would recover and I came very close to canceling altogether. I'm now so grateful that I perservered and went ahead with it. The surgery and recovery, although very serious, turned out to be far less than what I feared. This whole experience has been entirely manageable and this forum helped me through the long and anxious process. Without a single doubt, if I needed to, I would do it again in a heartbeat.
Peg