Question: To have a Nissen Wrap or not?

Hi there,

Hopefully I can answer some of these questions. The best answers you'll get will be from a surgeon during a consultation. I recommend you visit with one. It in no way means you have to get the surgery, its just an information gathering conversation.

1) Vomiting

It is not advisable to vomit after a Nissen, though multiple people here have without issue. My surgeon told me to avoid vomiting, but I don't think I would be physically unable to, just the force of the vomiting could impact the wrap.

2) Gas issues

In most cases these issues are only short term. Some folks do have more long term gas complications however. Seems like most people are burping fine by 2-3 months. But more long term complications are possible.

3) Wrap may need to be re-done

Its uncommon, but yes, in some cases the wrap needs to be re-done. You'll read lots of stories of that happening here and other places online. That's mainly because people who's wraps have not come undone have no reason to post on the internet about problems. My surgeon says that a properly done wrap on a well screened patient should last for life, but that there's always the small chance of a problem. That's really true with many surgeries though, my mother recently got a new hip, they tell you up front that it has a shelf life. At least with the Nissen, it could last for life.

4) eating normally

Recovery usually takes 6-8 weeks. Sometimes shorter, sometimes longer. But, eventually you will be back to eating completely normally. By 8 weeks I could eat anything and everything.

5) cancer

I would say that the Nissen REDUCES certain cancer risks. What is the biggest cancer risk from GERD/Reflux? Esophageal cancer. If the Nissen gets rid of reflux, your cancer chance drops pretty significantly.

I would imagine a surgeon would tell you your chances of other (non esophageal) cancers after Nissen are the same as the normal population. No type of procedures are done during the surgery that include radiation or anything else that could increase cancer chances.

Its a big choice to have surgery. Success rates are high, but complications are always possible. You will have to outweigh the risks/benefits and see if it is worth the chance. In my case, my GERD was so severe and causing such constant daily pain, that it wasn't a very difficult decision to make. I would have gladly taken some gas/bloating issues if it resulted in my pain being gone. Luckily, 10 months later, I have no complications and I have my life back.

Also, remember the scope of what you are reading online. Just like with anything (restaurant reviews, movie reviews, etc), it is much more common for someone to write online about a bad experience than a good. Most people who had a good surgery or any experience have no reason to write anything online... they are off enjoying the benefits. This is why you need to talk with a surgeon. They will show you real success/complication rate data. That's what you need to use when making your decision.

Good luck!

Thank you so much for your detailed repsonse! I have spoken to two surgeons and they both recommend having the procedure. In contrast, my gastro DR. suggested holding off. I am now at the point of having additional pain, so I thought I should reassess my options.

Did you know Robert Kardashian (father to Kim etc) died of esophageal cancer? I did know that was a big risk of the reflux. However, whenever you are messing around inside an area that is not normally accessed, it would seem you could be stirring things up (how is that for a very non scientific assessment? Ha)

We shall see what the next few weeks of research leads.

Here's my two cents worth...
I had a 270 degree wrap two years ago.
1) I can vomit. I've thrown up several times due to food poisoning and viruses. Wrap's still good.
2) I had bloating first 6 weeks, fine now. I was able to burp on the day of the surgery during recovery.
3) Yes, wraps do come undone, but the best way to make them last longer is follow the rules during recovery and make sure your doctor does all of the tests (barium swallow, EGD, pH test, Stomach emptying, and manometry test). Ask him about how many surgeries/repairs he has done.
4)I was eating normally at 4 months post op

What is 'floppy' Nissen mean? This was recommended. Bumper

Hi

I'm male and had my wrap in 2003 in the UK when I was 35.

In regards to your comments;

1) Unable to vomit - I couldn't after surgery and I still can't 9 years on.  I've only had a few instances of food poisining (or over-drinking!) in that time and tend to dry retch when this happens, but no damage seems to have been done - can't say this is a comfortable feeling though.

2) Gas issues / Bloating (can't burp) - I'm not able to burp either.  In terms of bloating I do sometimes get a bit uncomfortable if I eat a big meal, but mostly I'm fine - however raw red onion now seems to be very good at making me uncomfortable for some reason?

3) Wrap may not stay in place - may need to be redone. - 9 years in and mine is OK and I haven't had a single episode of heartburn since.

4) Can't really eat normally again - I had to eat puree'd food for 6 weeks after the op, but I can eat whatever I like now (although I stay away from red onion as above).  I learned very quickly to chew my food more, as if I eat too fast food sometimes gets stuck (this is especially true if eating something like sticky rice). As time has gone by this happens much less frequently (it's over a year since this last happened to me) - I guess I now just sub-concsiously eat slower and chew more without realising I'm doing it.  When food gets stuck it is quite an uncomfortable feeling and I tend to end up forcing myself to dry retch to dislodge the blockage.  One other thing, my sense of being full has altered and this sometimes means I find I have eaten too much without realising it - this is uncomfortable for a bit, but is no different to what it was like if I over-ate before the op.

No idea on the cancer front, but I was pretty much crippled by the reflux before my wrap so any small increase in risk has been well worth it to be symptom free for the past 9 years.

Hope things work out for you.

 

Greetings,

As I have said before, the "short floppy" gastric fundoplication (pushed by Donahue) is an abomination what was once a great surgery invented by Dr. Rudolph Nissen.

The "short floppy":

1.) Often, the short floppy Nissen does not prevent "all" acid reflux. No matter what any surgeon tells you, "size" does matter. The longer and tighter the wrap, the stronger the newly created sphincter muscle (valve) that prevents reflux. Surgeons who worship at the altar of "The Church of Short Floppy Fundoplication" will tell you that a longer and tighter wrap is "over kill" and is not necessary - which is pure baloney to those of us who seek a total cure from any and all reflux.
2.) The short Floppy is less durable than the "Classic" Nissen Fundoplication because less sutures hold the wrap together.
3.) Typically, the short Floppy includes separating the short gastric blood vessels. This has been shown to be the cause of "gas bloating" in many patients. There are no studies that show any benefit in taking down the short gastric vessels.
4.) Any surgeon who tells you that you should avoid vomiting, post op after Nissen surgery is a "piss poor" craftsman of his work. Why then doesn't he just tell you to avoid breathing air, too??

My Experience:

In 1998, I had an excellent bariatric surgeon perform a laparoscopic version of the "Classic" Nissen Fundoplication to cure my acid reflux. At five centimeters in length and with five sutures holding the wrap together, my wrap is very robust and stout (unlike the "short floppy" that is typically 2.5 cm in length with 2 or 3 sutures holding it together).

18 years later, I have had ZERO acid reflux incidents.

It is true that for five months post op, I suffered greatly from dysphagia. And, it took ten years before I could swallow all of my meals without any feeling of discomfort at all. But I believe in the saying, "no pain, no gain."

By the way, I can lift heavy weights, wretch and cough violently, vomit, belch gas, or eat any food I desire at any time of day or night and my wrap will stay intact and function, preventing 100 percent reflux of food and acid.

If you decide to have a surgeon perform a Nissen Fundoplication, remember that any surgery involves "risk." And, never let a surgeon use sutures made of any material other than "braided polyester." Some so called "surgeons" actually use silk sutures to hold the wrap together. Both silk and nylon lose 100 percent of their tensile strength after one year in vivo.

Best of Luck To You,


Johnny Rebel

Post Edited (JohnnnyRebel) : 3/25/2016 12:54:14 PM (GMT-6)

I am on the same track as CaliGal, I'm two weeks out from surgery and had my post op follow up yesterday.
I believe CaliGal gave great advice in finding a surgeon who is very experienced. Also, keep in mind that if you get the right surgeon, you may have to wait on him, they are in great demand!
As for your questions:
1) Unable to vomit
My surgeon says I could do that but he forbids it, lol! Seriously, he said do everything possible not to for at least 6 months. I have Zofran (generic).

2) Gas issues / Bloating (can't burp)
I do still feel bloated but I burped right after surgery. I've been able to burp anytime I need to although it's somewhat painful if it's when I'm eating. It seems there is a pressure issue, my surgeon says it's simply my swollen esophagus.


3) Wrap may not stay in place - may need to be redone.
I'll have to wait and see.

4) Can't really eat normally again.
During post op visit yesterday, I was advised to continue to stay off of meat, bread and carbonated drinks. Other than that, I can move forward cautiously. He thinks I'll be pretty much back to normal within a couple of months of so.

I asked about alcohol and he said two things: (1) No alcohol and meds..... that's not an issue since I have been off of the meds for one week. (2) No over indulging...... remember what he said about vomiting, lol!

Finding the right doctor is key, do lots of research. If you know a nurse in the general surgery area of a large hospital, ask him/her who they would want to do that surgery on them. The nurses know, trust me!

Good luck, you will make the right decision!

MartyW

Hi RRose, I wanted to let you know JohnnyRebel has not posted here in a little over 2 years. You may want to make a separate post of your own with your questions. You will more than likely get a much better response, people often ignore the older threads.

Take care.