Terrible heartburn after Nissen fundoplication

Dear all

I am desperate and need some guidance. I am 7 days post-op from a Nissen fundoplication to fix my LPR. Surgery went well and I had to stay just overnight in the hospital. I was able to move around and eat clear liquid fluids right away. Heartburn was gone immediately after surgery. I had the normal symptoms like fullness, a little bloating but not much difficulty to swallow. However, 4 days after the surgery I woke up with lots of acid in my throat and nose and since then I have this all the time; that coincides with not feeling so full when I eat. I saw my doctor today and he said this should not be happening and asked for a test to see if the wrap came undone. My question is: can this be possible? Can the wrap become loose in just a few days?

Post Edited (RDP74) : 11/23/2015 10:27:53 AM (GMT-7)

Sorry to hear that. My story is quite similar. 4 days after surgery a had burning on upper part of abdomen and strange feeling in my throat. I having it since now (10 weaks after surgery). I had barium swallow and 2 endoscopies and wrap looks normal and have no recurrent hernia but have gastritis and duodenitis. Now I just hoping that my symptoms will fade away in time (but its not working since now).

Are you sure it was acid? Might be just mucus or something else...

Wrap might be done wrong in the first place, but probability is very low. Lets hope we will be OK. Best way to see if wrap is working is endoscopy and pH-metry.

Good luck and please keep us updated about your results.

Hiya RDP74, hang in there,the odds of you getting reflux after a fundoplication are pretty slim.Foods and liquids can sit in your esophagus and not completely clear and this can feel exactly like reflux.This surgery can take a long time to recover for some people.
The fact that you are still taking PPis and still feeling pain and burning proves the point.I went through the same thing but i had a undiagnosed motility problem.
Give it three or four months and if theres no improvement you will have to get some testing done.
Try and come off meds. and see if you feel any difference.
Barry

Dear all

Here is another update - I am now at 4 weeks after the fundoplication
The past few days have been dreadful. My throat is in flames again with lots of saliva, despite of taking 40mg of Omeprazole. I still have some difficulty swallowing the food, but no chest pain or the sensation of food getting stuck above the wrap. The only thing that slightly helps is Gaviscon Advance, as it coats my throat for a while. I am quite convinced that my problem now is not acidic, but rather pepsin and bile.
I saw my doctor today and he told me to get off the PPIs. He said that the barium swallow didn't show any evidence of reflux, but the esophagus emptying is indeed slow. He put me on carafate and reglan for 4 weeks and recommended an endoscopy to check if the wrap is too tight. He said I may need to do a dilation if the tightness of the wrap is making the esophagus emptying worse. BTW, my pre-op manometry showed that I had a lazy esophagus. That makes me think I shouldn't have had the surgery to begin with.

I will keep posting updates as I am trying to get back to normal.

Hi RDP74 your story is somewhat like mine. I had fundo in 2001 not really knowing what for or without many tests just to solve heartburn problems that no ppi touched. Fast forward to 2010 heartburn back but with nausea. I had 3 manometrys 3 endoscopies everyone proved no reflux. I reached a point where I knew this burning into my throat even up to my ears was wrong. I live in UK , by using google I found a doctor who does re-does of my op. He was wonderful although I had to go through all tests again, the best was a high resolution camera on a manometry which told me I have a moderately severe motility problem. My oestophogus just does not function well. The Consultant re-did the op reversing a 360deg to a 180deg. I was informed this would probably not stop the burning but cured the nausea thank goodness. I think maybe you have a lot of recouperating to do yet, this is a difficult operation which needs lots of recovery time.

Dear all

I am back for another update. I am now 8 weeks after the Nissen and things started to get better. After talking to my doctor, I started taking Reglan to help the movement of the food through the esophagus/stomach. I noticed a significant improvement after that. I am also taking Gaviscon at night before going to bed. I can now eat and drink anything I want and I don't have the feeling of being stuffed up or things getting stuck around the wrap. My throat is still sore, but I don't have the lump feeling anymore, neither the constant throat clearing. I do, however, feel some bitter taste in my mouth occasionally. At night, I can finally sleep laying completed flat and I don't feel the acid coming up to my throat. Overall, I feel much better now than I was right after the surgery. I read that it can take 4-6 months for the LPR symptoms to disappear after Nissen. That's much slower than those who suffer from GERD.
So, overall I am optimistic that I am in the right path. Hopefully soon, I will ditch all the medication at once.

Dear all

After a short period of what I thought it would be a path to recovery, things went back to be terrible again. My symptoms have worsened dramatically. I now have a 24/7 burning mouth/tongue, sore throat, congestion and my tongue is covered with a white/yellow coat and white patches. After seeing an ENT specialized in LPR, he re-directed me to a new GI doctor. The new doctor asked for all the tests to be redone to compare to what it was before the surgery. So far I have completed all blood work, including a test for Chagas disease and scleroderma, both of which can affect the GI function. Both came out negative. I am repeating the endoscopy, manometry, pH study and GI emptying test in the next few weeks. I do believe that I have some mild dysphagia, as I have problems getting food through my throat and a little pain in my chest when I eat big chunks. I did a second barium swallow that confirmed mild dysmotility and delayed clearance.
At this point, I believed I shouldn't never have done the Nissen. I think my surgeon jumped too quickly into the idea of doing a wrap. My DeMeester score before the surgery was 7 (normal is <14,72) with 46 reflux events (normal is up to 72). 15 events were acidic and 31 were non-acidic - 22 reached the proximal (closer to the throat) region. I have complete aperistalsis of the esophagus. My interpretation is that I didn't have abnormal reflux, but whatever events I had remained in the esophagus for longer time and hit my throat. Now, with a tighter wrap, I assume clearance is even harder. I will confirm this in the next manometry. Truly, at this point I just want to have the wrap undone. I could live with a mild sore throat like before, but I certainly cannot live like this.
Anyone out there with similar cases? Has anybody gotten his/her Nissen reverted?

Post Edited (RDP74) : 4/12/2016 3:45:20 PM (GMT-6)