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Paraesophageal hernia repair, is a Nissen necessary?

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Posted 7/7/2015 11:55 PM (GMT 0)
Hi everyone,

I was here before but lost my account login information, so if my story sounds familiar thats why. I have a paraesophageal hernia (PEH). I have had well controlled gerd for the last 20 years. I've seen 4 different surgeons now about my repair and have had 4 different opinions. My symptoms are chest pain, a constant dull ache under my sternum, back pain and sometimes pain in my neck and throat. Here are the opinions I've gotten

Surgeon one - large university - thoracic surgeon. Surgery is not emergency but should be done because it's only going to get worse. It probably will not resolve any of my symptoms as they are atypical of PEH. He would do a robotic laparoscopic procedure with the PEH repair and Nissen fundoplication. He said I will no longer be able to burp or throw up.

Surgeon two - bigger large university - thoracic surgeon with specialty in esophagus disorders. Because I do not have any of 3 major symptoms (reflux that comes up, food sticking, problems swallowing) he would not recommend surgery as he does not believe pain is due to PEH. Refers me to a gastro doctor.

Surgeon three - general surgeon specializing in GI issues local hospital - Recommends laparoscopic repair with Nissen. Downplays all side effects, I will be able to burp throw up etc and will be out of hospital quickly with very little lifestyle change.

Surgeon four - thoracic surgeon different local hospital. Takes time to show me barium swallow and test results. Says because my esophagus has remained in place under the diaphragm this is why I'm not having the GERD issues most people with PEH have. Suggests pulling down the hernia, repairing the diaphragm and leaving it at that.

One of my biggest worries is about my inability to throw up. I have what I call weak stomach and am often sick from food poisoning and stomach flu etc. It seems like I catch everything and am often sick. The other is losing the ability to burp as honestly carbonated beverages have been a lifetime feel better drink for me when I am sick, burping makes me feel better and without it I just can't imagine.

So from my long story I'm looking for opinions on if you think the Nissen is really necessary or not and what you would do or think in my situation. I truly believe all 4 are very qualified gifted surgeons so it's hard to choose. I keep going back to the surgeon that will just repair the hernia because I really don't want the Nissen unless it's absolutely necessary.

Thanks so much for your time and opinions!!!
Posted 7/8/2015 1:06 AM (GMT 0)
Hi Michiganmom,
I had a large PEH repaired (non biological tissue PEH) with a full wrap nissen fundoplication. I had progressed to the point where I really wasn't suffering with the gerd because of how large my hernia was. My doctors told me my hernia would not get smaller and if fact could get larger. He also said the size of my hernia was probably masking the gerd and once the hernia was fixed I might start feeling the gerd and have to go back on medication. I was tired of all the medication and symptoms from the medication that I decided to do the complete surgery as I was concerned fixing the hernia would only allow the heartburn to start up again as the LES didn't have much of a closing mechanism left. I was terrified of having this surgery as I too have a sensitive stomach. I didn't want to give up burping or the ability to throw up if needed. My surgeon was very skilled and assured me that I would still be able to burp. He took measurement/results of my LES mobility test and used that info to make my wrap the right size. I'm able to burp without any problem. Don't know about throwing up but I'm willing to take nausea medication or go to emergency room if needed. The relief I have from the surgery is worth it to me. I've had a very easy recovery (3/23/15 surgery) and am back to eating everything without any problems or gerd. I'm not on any medication.
With all that said, I would ask your doctors about your LES mobility and if it's strong enough to prevent gerd after you repair only the hernia. The test I'm referring to is called a manomertry test. Sounds like you're on the right track by asking for opinions and seeking multiple Drs. opinions.
I hope that my experience provides some insight. Good luck to you.
Posted 7/8/2015 1:20 AM (GMT 0)
Oh my goodness. With just a few differences, I am in a very similar situation and have had almost identical recommendations from 4 surgeons.

It has been incredibly difficult for me to make a decision. Plus, there are some insurance and timing issues.

The # 4 option you mentioned - which I would prefer greatly - is a doctor out of state and out of my insurance network. So it's really cost prohibitive. Yet, the after effects are likely to be greatly reduced.

I'm pretty sure my e-mail is in my profile - running out now. Please contact me or let me know if it's not there!

Take care.
Posted 7/8/2015 9:52 AM (GMT 0)
I had a paraesophageal hernia surgery 12 weeks ago and had Nissen fundoplication surgery an glad I did. Had some of the same symptoms as you. Large hiatal hernia for years. Also got the pain in my left shoulder into my neck lasting a few hours. Hiatal hernia was twisted and stomach was twisted. Could only eat half a meal then was still too full for dinner. Only good thing lost weight.

Had surgery one 12 weeks ago by a bariatric surgeon at Cleveland Clinic. I am 75 year old. Was not worried about surgery. Just wanted to feel better. Have no problems. Can burp with no problem. I try not to drink soda because they say not to. But I have a few times and even through a straw and seem to have no problem. You will just have to eat slow, chew your food well and cut food (even bread toasted) into small pieces. Good luck and go for it.
Posted 7/8/2015 9:55 AM (GMT 0)
Also am on no meds. Nexium after surgery for just a month. Had been on Prilosec and then protonics for many years.
Posted 7/8/2015 6:11 PM (GMT 0)
Hi and thank you all for your opinions and information -

Fundrider - I am so glad you had great surgery results. Do you mind if I ask what state you had your surgery in? I think what bothers me most about the surgeons wanting to do the fundiplication is that none have suggested manometry or any other form of testing to determine how tight the wrap should be. They make it sound like they leave it on the floppy side but I have to believe there is some science that can guide them to what is right for each person. I have never had any problems with the medication, it doesn't bother me so I tend to lean towards why change something if it's working? It's interesting your doctor thought the hernia was masking the symptoms I had never heard of this.

YinYanger - I'm going to try and email you today. Would be interested to talk to you about your journey.

Teapot01 - glad you are having good results with your surgery!!! Toasted bread forever though? Thats a huge lifestyle change for me, I live on sandwiches :)
Posted 7/9/2015 1:04 AM (GMT 0)
Live in South Florida. I would love a sandwich but right now I might choke on it. Bread now is best toasted. I never asked all the questions about and nobody ever asked me. I do know that I do not have mesh. The doctor did mention that and I thought that sounded good Ann
Posted 7/9/2015 3:16 AM (GMT 0)
I live in San Antonio Tx. I had one surgeon say the manomertry test wasn't needed and the surgeon I picked would not do the surgery unless I had it done. The surgeon I chose does about three of these surgeries a week and requires this test on all his patients. He's done over 500 of these surgeries and assured me that the test would be worth it in order to give me the best results. He said the mobility test allows him to gauge the strength of the LES and therefore how tight or loose the wrap needed to be. He didn't want to just rely on the bougie they insert during surgery to determine the strength of the wrap. I guess every surgeon has their method of determining what is best for their patient based on their experience and chosen technique . This was just my experience and I felt very comfortable with it. Sounds like you're doing the right thing by preparing yourself with as much information as possible.
Posted 7/9/2015 11:16 AM (GMT 0)
I had the NF and hernia repair last year, best thing I ever did! My surgeon would absolutely not do the surgery without the manometry.
Posted 7/9/2015 7:15 PM (GMT 0)
Ann I'm sorry you can't have sandwiches and I certainly don't want you to choke so probably best not to go with bead thats not toasted. I also am looking for someone that will do my surgery without the mesh. All 4 surgeons I saw said they would not use mesh and that most surgeons are moving away from it for this type of surgery.

Fundrider the 1st surgeon I saw had done about 250 of these surgeries. He did ask me if I'd have a manometry test done but I told him no. I did however have some type of test where they measure how quickly food moves through my system and that came back with really good results so I"m not sure if thats why he felt I didn't need to the manometry. I'm trying to prepare as much as possible but it's hard. There is no 'right' answer. All I can do is keep asking the questions and make the best decision I'm most comfortable with.

SharonZ I"m happy to read you had great results too. Do you mind if I ask what types of symtoms you had before the surgery?

Thank you all!!
Posted 7/22/2015 6:46 PM (GMT 0)
Hi All,

Wanted to check in and say hello. I decided to go with the option that doesn't include the nissen repair. Met with the surgeon again this week and feel I'm making the right decision. I'm having the procedure done next month, wish me luck! :)
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