Should I get a Nissen re-do? (Had the procedure at 2, 33 now)

Hi there. I'm hoping for some advice if anyone has been in the same boat as me or might have some insight.

I'm a 33 year old male who had an open Nissen Fundoplication at 2 years of age. I remember the procedure and the recovery period afterwards, 8 days in the hospital (they let you stay a lot longer back then), and several weeks without solid food, but when you're a baby you just take it as par for the course.

For most of my life the surgery seemed successful and was simply an afterthought, except I've had asthma since I was a child, no doubt exacerbated by the GERD. Over the last few years symptoms that I didn't originally think to be related to all this started to manifest: anxiety, chest pain, waking up wheezing most mornings.

Doctor's couldn't figure out what was wrong with me. Eventually I went to see a GI a year and got an upper endoscopy. It showed that had a hiatal hernia and that the Nissen wrap had come partially undone and herniated through the diaphragm. I was prescribed omeprazole and otherwise he didn't think it seemed too serious. I took it for a while without any real benefits to the anxiety/wheezing, and kind of dismissed it as the cause.

about two months ago it got worse. I went to the ER pretty convinced my symptoms were caused by acid reflux or else just the hiatal hernia. I got a battery of tests done, another endoscopy, a manometry, and UGI panel, and just finished speaking with the surgeon today.

They discovered a couple of concerning things. The contrast from the UGI was getting stuck in the herniated portion of the stomach, and it almost seemed twisted/angled as it reached the diaphragm. Additionally it's decently into my chest cavity that he said they'd think surgery would appropriate for that case.

On the other hand, he told me that a redo Nissen is darn major surgery, and that because it's a redo, and because my first one was done as a baby it's possible there's gonna be major scar tissue. If there is, he may not be able to do it laparoscopically. So it's a 50/50 crapshoot based on what they find when they open me up and do the full procedure.

On top of that the manometry showed that I do have peristalsis, but it's weak. That concerns me when it comes to getting another wrap done. Has anyone had a wrap under this scenario?

Finally, I'm worried about side effects, damage to the vargus nerve (he told me this was a possibility), inability to swallow, etc.

I'm leaning towards just getting the surgery. The daily symptoms the last two months have made my quality of life pretty terrible. Luckily, they seem to get worse at night, so my work has been more or less unaffected. But I have wheezing/chest tightness when I wake up every morning and at night, chest pain/discomfort after eating for an hour or so, and just a general feeling of discomfort inside my torso. It's incredibly disconcerting. I've never really had heartburn, so I'm not sure if these are what the symtoms of it feel it, but to my mind it seems more likely that the hernia is pressing up against my lungs causing all this discomfort and shortness of breath.

Finally, the surgeon told me that I could take my time and decide, and that my immediate health wasn't at risk, but darn if it doesn't feel like I'm gonna stop breathing or have some major internal hemorrhage every night. Can anyone else relate to that, who's ended up being find for years on end? I've always had anxiety but this is next level.

I know that was a lot, I appreciate the time for reading and any input.

-Ryan

Appreciate the reply. I've been trying almost everything (ashwagandha, nightly melatonin (a few studies from overseas showed huge LES improvement with melatonin use), diet, etc). I've stopped drinking entirely. I'm thin, I'm very fit, but this keeps getting worse. I've got chest tightness and what feels like a lump in the middle of my lower chest (behind my sternum) about 50% of the day the last 6 weeks. I'm sure my loosened wrap is pushing up against my lungs in some way.

I think I'm going to end up scheduling the surgery. I'm pretty terrified by the potential side effects, but I've had this surgery before and I can't imagine living like this much longer. Between the physical symptoms and the near daily panic attacks they're triggering, my daily quality of life is extremely compromised.

I'm assuming from your post history you got the surgery and had bad side effects? Can you describe it for me? Also, I'm open to any other suggestions before I actually go ahead and get the operation.

I agree with having a second opinion, I think it will help in your decision-making.

Sharon