Robotic-assisted gastroesophageal valvuloplasty with Vicryl closure of the hiatal hernia- no wrap

I started my own topic because there are so many people with a failed or bad side effects from the Nissen wrap procedure. There are others who have a hiatal hernia (HH) and are considering the Nissen wrap. I had another procedure with Dr Farid Gharagozloo in Celebration Florida, which you should consider. If you are able, see him for a consultation. You can call or email his office with questions (email address in in link). He is located in Florida and he discharges you to home after surgery. I do not work for the office nor am I a representative of the office. The operation was fairly easy to heal from as compared to the Nissen wrap which can take up to a year to heal from. I want to share my experiences and others with you.

Dr. Gee does a takedown of the Nissen procedure and the valvuloplasty. I saw an individual in the waiting room who underwent this procedure. She had difficulty swallowing food after her Nissen and could she expel gas. She was in a tremendous amount of pain and very uncomfortable (was the wrap too tight?). The procedure was accomplished through a incision in her back and, even though she must have been in a tremendous amount of pain, she was content with her outcome. After my discussion with her I knew, even before I met the doctor, that this was the operation for me.

For those who haven’t had previous surgery, through six small incisions in your stomach, Dr. Gee performs valvuloplasty with Vicryl patch of the hiatal hernia. He has done the procedure since 2000, and has been in Florida for over a year where he has done over 500 procedures and we have no long lasting side effects. He has documented his procedure and there is lots of information online. I had the surgery one year ago and I am doing well now. I did have some inflammation in my esophagus and stomach postoperatively, but it is resolving. We have no side effects with gas, belching or difficulty eating food. He sends out questionnaires to all patients postoperatively so he know how we all are doing.

During the procedure, a valve is created between the stomach and esophagus. which opens and closes as you eat. I should say he recreates the valve that was there before the HH, which is a more natural procedure. The HH is closed with a Vicryl patch, which eventually dissolves postoperatively. He does not wrap the stomach around the esophagus as in the Nissen.

The outcome of the procedure is excellent, and I am doing well. My surgery was in 12/2016.

Here are some resources; In the GERD forum, there are several of us who have had the surgery and it is under “7 Days Post Op - Hiatal Hernia/Gerd Surgery” and “hiatal hernia repair without the wrap?”. On FB there is a site for people with Nissen issues and it is called “Nissen Fundoplication Takedown”. There are 435 members and they all have problems with their wraps. Some have even had a takedown. There are many Nissen wrap postings in this forum. Take a look at them.

Online resources publications for your review.

YouTube presentation of the procedure: https://m.youtube.com/watch?v=c-stGNeQy6M

Study of patients who underwent procedure:
https://www.sages.org/meetings/annual-meeting/abstracts-archive/robot-assisted-gastroesophageal-valvuloplasty-an-alternative-anti-reflux-surgical-procedure/


We are on a FB site if you want to learn more about the procedure. https://www.facebook.com/groups/1647211462073684/



Yellow, you have been posting about this particular dr for a couple of months. You have stated you are not affiliated with this dr in any way. The admin prefers that we do not put drs info in posts as you have. You can enable your email address in your profile & any if anyone is interested in your dr they can contact you via email. Glad to read you are doing well.

Post Edited (Yellow19) : 5/2/2019 10:22:33 AM (GMT-6)

I had this surgical procedure plus more internal repairs 16 weeks ago at Celebration from Dr. G. I have lung damage caused by the years of cough and nausea. I just had an endoscopy from Dr G. a few days ago to see if the base of the esophagus needed to be dilated since I still can't eat or drink very much without the cough and nausea. The endoscope showed that the valvuloplasty is intact and healing well and there was no narrowing of the esophagus to be dilated. I just have to deal with an additional condition I have of an esophagus that doesn't send to food down to the stomach the way it should. Now I eat and drink a very small amount every hour. I will do whatever it takes to give my lungs a break from the aspiration induced damage so my lungs can regenerate. I am so grateful to have Dr. G and his team on my side, along with my pulmonologist.

Hi Yellow1955--I just found out about this procedure (gotta love FB peeps) and would consider this, too.
I am only few hours from Dr. so going for consult (and more) would not be an issue. I am curious if you had Barretts Esophagus? LPR? I will keep looking for info on line until I get back to local GI and get all my biopsy results. No matter, I am out to fix this situation. I am 65 and do not want to spend my remaining years in worry and misery.
Karen

Thanks yellow. i will contact DrG this week. I had a sleeve gastrectomy 7 yrs ago and I hope I can still be a candidate for this procedure. I will post more as I find out more. Thanks again.
Karen

CJrose, after you have the surgery post a diary to let us know what you are gong through. It won’t be a long diary because you will be all better shortly after you get home. It was such a surprise to me that the procedure is so extensive and the postoperative period is so short. I feel so good, and can eat whaever I want that I have trouble keeping weight of, which is essential for me. I had my surgery 12/2016.

Post Edited (Yellow19) : 5/2/2019 10:24:18 AM (GMT-6)

Hi friends. I have a few questions about this procedure. I had a Nissen two years ago, and it has slipped a bit/gotten loose, leading to even worse reflux/LPR than prior. :-/

This procedure sounds great, but

1. How do they protect the part of the esophagus that goes into the stomach form acid/Barrett's development, etc.? Perhaps it's scar tissue after the operation?

2. Do they use any materials (like plastic surgeons sometimes do) to build the new valve?

3. How do they guard against short esophagus issue, which I've read can try to pull everything back up (recurrent hernia)?

Thanks for your insights.

p.s. -- I mentioned this procedure to my doctor, and he replied with "That sounds terrible!". He did not clarify why when I asked. :-/ I don't think he's familiar with it.

Post Edited (AppleBananaPear) : 3/5/2018 3:07:59 PM (GMT-7)

Delrose, I was afraid of the Nissen procedure which is why I steered clear of it. I heard the postoperative complaints,and I thought I was better off without it. I, however, didn’t realize how serious my condition was. If my blood supply to my stomach was cut off, it would have been very bad.

Do you have to eat a special diet? From what I can understand about the procedure, the stomach is wrapped around the esophagus, so you are missing some of your stomach. Many people have to avoid fried and fatty foods, otherwise they get sick. I’ve read that there is a postoperative diet that the surgeons don’t tell you about.

Post Edited (Yellow1955) : 3/5/2018 6:08:36 PM (GMT-7)

AppleBananaPear, good questions. I was in a panic mode when I joined this site because my GI told me he saw no evidence of the surgery. My GI hadn’t seen anyone postoperatively, so he was in a learning mode. He didn’t understand what he looking at. He is one of three GI’s in Celebration and that told me that not many people had inflammation like I did. I made an appointment with Dr Gee but it was postponed. I communicated with Fitboy and found out that there is some inflammation postoperatively, which makes sense because your esophagus and stomach are reconstructed. I actually learned a lot from individuals who had the surgery after me, and from the FB site.

I’m not sure if the inflammation had anything to do with the surgery because I was so upset over my brother, and may have gotten it anyway. Every week, there was more bad news until he withered away to nothing. When I looked into what was wrong with me, it was almost one year after surgery.

My GI doctor put me back on PPi’s and Carafate. I felt better right away. I eventually cut back the PPI’s and went off the Carafate. I’m still on 20 mg of Paratopranole. I could try to get off of it, but I feel fine with my status so I’m in no rush.

This procedure is permanent and after the procedure, there is no more reflux— but go to see Dr Gee and ask questions. He puts no time limit on seeing new patients. Reflux actually is the acid coming back from the stomach into the esophagus - which causes the damage.

Dr Gee reconstructs the valve that has broken down, which closes after you swallow —so there is no more reflux.

The valve closes and prevents the stomach acid from backwashing back into the esophagus.

Everyone has this valve except for those with a hiatal hernia.

He patches the hiatal hernia closed, and all sutures and the patch dissolves. The patch is something like a sugar substance.. I would question him more about this part of the procedure. How does the hernia heal with the patch? How long does it take? Make sure he draws you a diagram.

Post Edited (Yellow19) : 5/2/2019 10:26:34 AM (GMT-6)

I didn’t realize the email was taken out of my post. I updated my email address in my profile. Email me and I’ll give you the Doctors name and email

Hi all, I thought I’d post an update. I still am weaning off PPI’s. I feel great - no heartburn or acid reflux. I plan on taking my time getting off PPI’s. Hope you all feel just as well. I’m on 20 mg of PPI per day.

DannyAub, My email is correct. You can post your questions here. I heard from two people:

1. “ I am new to this forum after doing a google search. I had two failed Nissens and also two failed hiatal hernia repairs (in which they used stitches to seal up the hole where the stomach protrudes into the esophagus. I have been considering the Linx procedure and having the hiatal hernia stitched up.

Did they use mesh or a dissolvable mesh to repair your hiatal hernia? Also, Is there a Website that explains your procedure for your acid reflux clearly?”

I referred her to this link for documentation on the procedure. I’ll also sent her a copy of my operative note.
Yes the mesh dissolves during the postoperative period.

2. Another individual contacted Dr Gee and she made an appointment, which was cancelled because of a power outage. She never had surgery but gets reflux at night. (I did too so I know how painful that is). She will contact me after she sees Dr. Gee.

Post Edited (Yellow19) : 5/2/2019 10:32:41 AM (GMT-6)

1ana, so glad you are doing fairly well. Now that you mention the burns flake off, I remember him saying that also. Something I had forgotten. He keeps his patients on 6 months of PPI’s now. Some items that may help include: I remember that I gave up coffee for a while, as it seemed to be the culprit. Also I didn’t drink alcohol or spicy food when I had the esophageal pain. At night, I tried something to coat my stomach such as milk or tums. If it continues, go to the GI, he can give you Carafate. I was on it for about a month and it was a miracle drug. Check in and let us know how you are doing. Some are bothered by the esophageal pain, others are not. I wonder if it has something to do with the amount of damage that was done to the gastroesophageal area preop. Our stomach was up in our chest, so our anatomy was screwed up.

Taper off the PPI’s gradually. I have 20mg pills, so I cut down to one and two pills every other day for as long as necessary, maybe one month or two (or more). My mistake was when I got down to one, I keep cutting it out right away, then I had to go back up to two. I think your stomach lining is use to a certain amount of help against the acid. I actually do fine on 20mg per day so maybe it isn’t as important for me to get off of it. I have been on PPI’s for 30 years, and 20mg is not nearly as much as I have been on.

Post Edited (Yellow1955) : 7/22/2018 3:06:15 PM (GMT-6)

SIDSIN, you can go back to lifting weights after you heal 2-3 months after surgery.

Post Edited (Yellow19) : 5/2/2019 10:33:39 AM (GMT-6)