180deg fundoplication recovery journal

As promised heres my recovery so far.

Had the surgery late on Thursday afternoon (3rd Dec) after some delays with the anesthesiologist. It went smoothly and thanks to sticking to the diet before the surgery my surgeon gave my liver a clean bill of health, he said it was "slim, clean and no signs of fat in it" which is good because those following my pre surgery posts will know I was having problems with fatty liver earlier in the year.

The surgery was a laproscopic anterior fundoplication, 180 deg. When I woke up I had blinding shoulder pain from that darn gas they use during the surgery, but a few hours later once I was able to get up and shuffle round a bit it had vanished. The actual surgical site and incisions felt fine. No pain from them, just a lot of discomfort, sort of a tugging sensation which is a little unnerving but its not painful at all.

I came home after 2 nights in hospital once I was drinking and eating enough that I could come off the IV. I've got panadol, codiene and an anti nausea drug prescribed. I'm taking the panadol regularly, but I haven't needed the codiene, and had the anti nausea meds once or twice. I'm not prone to nausea or vomiting under any circumstances but I don't want to push my luck with this.

So I'm at day 3 now the pain is completely bearable. Sometimes after eating the shoulder pain will return a bit, the surgeon said this will just be from the stitches in my diagphragm. Walking round for a bit seems to settle that down. I've been very careful with my eating, I had apple sauce and some soups made up before the surgery so I just have some or some thin mashed potatos every few hours, maybe 1/4 cup at a time. Nothing has gotten stuck yet, the nurses were worried about one of my medications, venlafaxine, which doesn't come in liquid form, and how I would handle taking them because I had gotten a smaller size capsule so it would be easier to take, but it means that I am taking 5 instead of the 3 I would normally. I just make sure I take them very slowly, over about 10 mins, with just enough water to get them down, and make sure I'm standing up straight and walk around a little bit when I do.

about the only things bothering me at this stage is the gas, I could burp immediately after the surgery but now I can't, I assume because of swelling, so I'm getting quite gassy, walking around does seem to help move it down though. The other thing is that I just can't seem to get comfortable no matter how I sit or lie so if anyone found a solution to that one I'm all ears!

Post Edited (jenagade) : 12/8/2015 1:38:35 PM (GMT-7)

Hiya jenagade, happy days! You're doing really well by the sounds of things. The shoulder pains are a killer,i had them for some months after surgery but they do gradually disappear.
We've had the same type of wrap an " anterior" one which i never heard of until my surgeon mentioned it after the op. I can tell you that it works perfectly with no reflux or heartburn whatsoever.
All the Best! Barry

Day 4 - TMI warning, dumping syndrome has begun

I had a rough night last night, so much trouble getting in a position where I wasn't sore, so I was awake for most of it (not unusual for me).

Today also bought on lots of gas, and my old pal dumping syndrome. It seems very different to how it was back in May when I had my gallbladder out, after that I would get super painful stomach cramps, sweats, nausea and loose bms. This time my stomach gurgles and bubbles like crazy, completely painless, then followed by watery bms. I'm hoping that this is just dumping syndrome and not something else, so if someone else could weigh in with their experience that would be great. It seems timeboxed to within 30mins of eating something, and has only happened after having things with traces of dairy, or some puree I had made prior to the surgery from carrots, potato, onion and celery which I used to make my vegetable broth, I figured with how well cooked they were it wouldn't be a problem but I guess I was wrong.

I've started adding codiene back into the pain killer mix now. The pain is bearable with just panadol, but as my fiance keeps saying why put up with any level of pain. I've been hesitant to use it unless I was in seriously bad pain because I didn't want to get backed up, obviously not a problem now, but I'm still concerned that it might exacerbate the gas, and I don't want to have to end up taking simethicone for the gas because that could just end up speeding things up at the other end, so I feel like I'm between a rock and a hard place at the moment.

Jenagade, I had the surgery the day before you at the Army Hospital on Fort Hood. I've had many of the same symptoms as you. I still have intermittent pain from the incision sites (7) and feel a tightness in my chest which I think is from them tugging on my esophagus. I'm virtually off pain meds but I still take the anti-nausea pill and a stool softener. I also put extra fiber in my water so it makes it easier when I have a bowl movement. I'm taking in one day at a time in hopes that everything goes well. Good luck with your recovery. If you need to chat, my email is [email protected]

John

Day 8

Weight loss since surgery 4kg/8.8lb

The pain has died down again today, I think my diaphragm was spasming a bit it felt like there was a belt being pulled tightly around my ribs, and it of course shot the pain up to my shoulders as well but its eased back to what it was.

I've worked out the trick to stopping the dumping syndome too, I just have to be super careful about not having any fluid with food and making sure there is some protein or soluable fibre with each meal. As I said yesterday its not at all a normal thing this soon after surgery so I don't want to worry anyone about to get the surgery done. Its more common further on in the recovery, but still not that common and its manageable once you work out whats causing it.

Some people opt for it over the full 360 wrap due to motility issues. In my case my surgeon and his colleagues refuse to do nissens because the rate of side effects from it isn't worth the slightly higher long term success so they will only do anterior 180 fundoplications.

Because he has had over 30 years of experience doing laproscopic and non laproscopic anti-reflux and baritric surgeries and the success rates of his patients who had 180 deg vs those who had 360 deg was maybe 3-4% less over 10 years, in the shorter term they are equal. Yet the nissen has a high incidence of dysphagia, gas bloat etc. whereas the looser wraps do not so about 10 years ago the surgeons at his practice collectively decided that there was not a significant enough outcome with the nissen to continue offering it. The decision to have it as 180 deg was completely out of my hands, they wont do it any other way.

However the 360 is the gold standard surgery, tighter wrap is obviously more likely to stop reflux, but I can tell you that mine is tight enough that it has stopped me burping for a few days, so thats pretty darn tight. I can burp a little bit now and will probably be able to do more once its healed, but I doubt theres any acid getting through there. The partial wraps are often used in cases for people who have swallowing issues because there is a significantly lower chance of dysphagia following the surgery. With the nissen almost everyone experiences some level of dysphagia from it.

Hey Jen,
I’m sorry to hear it’s getting worse and not better! My left shoulder is also the worst part of it right now too, though it’s no worse than it has been. All along the shoulder pain has been the most painful part. I feel pain all across the round part of my shoulder along the bony part up to my neck and even up along the neck and in the back of the neck. It’s a hard pain to describe. It’s strange because I don’t always have it when I wake up but eventually at some point in the day I will have. For example…
Today I had my first post-op with my Surgeon. I spent about an hour getting ready, washing and drying my hair, makeup, etc. and than it was a good long hour and a half in the car to get there. No pain in the shoulder or other symptoms until just about before I had to go in for my appointment. It takes a few hours before the pain really kicks in. Normally i wouldn’t notice it as much but I wasn’t on any medication since I had to drive myself to the appointment.

He didn’t speak to me at length about it and didn’t seem concerned, but that it was likely related to the stitch he put in my diaphragm to correct the hiatal hernia. He said there could still be gas up there and to keep taking the gas-x. He doesn’t want to see me again for another 2 weeks. Because of the holidays, it’ll be 3.
I have read on these boards and elsewhere that it’s not common to still have the shoulder pain but it’s not unheard of either. We may be the special small percentage that gets it. Lucky us. I’m still taking the vicodin, does the ibuprofen do anything for the shoulder pain?

The nausea is new- has only started happening the past few days. Initially he only gave me the Zoran prescription because I have motion sickness, just as needed. So, I don’t know why I’m having nausea now but since I didn’t have the pills with me, they sent me home with some so I could make the 1+hour drive back home. They work ok, not great. Ultimately once I got home and back in bed with the heat on my shoulder, that’s when I feel “good” again.

I was supposed to go back to work today (my office job is very flexible) but I stopped in for a moment and decided I wasn’t ready for it today after having been through so much during the day. Tomorrow’s another (half)day!

Jenagade-thanks for the tips. My nausea seemed to come out of the blue. Wasn't a problem until this week. I always feel like I have a belt around my chest and throat. It was the worst GERD/hh symptom I had. Still hasn't gone away, I hope it does. Doc told me.i could test out.my wrap with coffee or wine whenever I'm ready. I'll definitely not ready until the nausea wears off, then coffee will be my first test. I can't wait to hear about your appointment. Keep me posted.

I'm sorry to hear that Craine, it sounds like you are having a rough time with the pain. Good that you are able to work from home, thats what I'm doing as well but my brain definitely couldn't cope with going into the office.

I think I need to bite the bullet and find a different protein powder to the one I currently have, vanilla pea protein (blergh!), I've been trying to find ways to make it palatable to no avail, which is a pity because it is the only one I've tried that actually agrees with my stomach. Whey is an absolute no-no right now, and I'm hesitant about soy because it can tend to make me a bit gassy.

My dumping seems to be directly related to how much liquid I have, unfortunately from trying to moderate that I have accidentally made myself pretty dehydrated which obviously wont help the nausea.

As for my post op appointment - incisions look fine, the tight band feeling in my chest is as I thought the irritation from the stitches in my diaphragm and should die down over time, he reckons about 3 weeks. From next week I can start trying more foods, I guess because it was only a 180 the risk of things getting stuck isn't quite as bad, I certainly haven't had problems yet. As for the diarrhoea he is getting me checked for C Diff, he confirmed its not normal this early, especially since thats all I've had since the surgery, no even close to normal BMs. Aside from that he has prescribed me Immodium and said to only take it once a day when I need it, so that I don't get blocked up but I can still try and get some more nutritious food in without it causing problems.

The good news though is that my reflux and regurgitation is gone! Not on PPI's anymore! Have had the absolute best sleep ever since the surgery, after horrendous insomnia - I never realised how much of it was just because of the reflux. The wedge has been banished and I am lying flat again which probably helps the sleep situation too. So overall the surgery has gone well and had the desired outcome, its just this diarrhoea getting me down, but hopefully it is just dumping syndrome and not C Diff, and it will go away in time.

This is a really interesting thread. I've been suffering for 15 months now. But if I look back I've had awful heartburn at least since I had my kids 17 yrs ago but I thought it was normal and just took swig if Gaviscon when needed.
Then 2 years ago I got the dreaded "heart attack pain" and I've had several severe ones since (last one was this sunday just gone I ended up in A&E cos of it :( )

And last spring got diagnosed with gastritis which was horrendous pain and that's when they found my 2cm sliding hiatus hernia. Been in constant pain for the last 6 weeks ranging from mildly uncomfortable to moderate and stressing me out to 2 occasions when it was severe (mind you I had 5 days when everything disappeared but then it came back :( )

Right now tge pain is under my ribs and at the top of my stomach. My doc thinks I've got a good chance of being given surgery. So fingers crossed for me when I see the consultant on Jan 26th (can't come soon enough)

I had exhausted all other options so surgery was my only hope. So far it is proving worthwhile and once I get on top of these digestive issues I'm having (surgeon thinks it might be C Diff) I'll be very happy.