hopes about esophyx

Hi,
I am new to this forum. Unfortunately, I have been recently diagnosed with Gerd and Haitus Hernia.

To make a long story short, it all started about three months ago after I caught a flue of some sort and since then had got all the symptoms that make my life miserable.
I am a singer which makes it especially hard for me. I don’t want to give up singing. It is probably one of the few things I really enjoy doing and I also feel I do well.

I want to consult with people here that have similar issues such as mine. I researched the internet as much as I could to learn of possible treatments.

So far, I can manage the symptoms well with the aid of the medicine, but it isn’t perfect and I have a hard time singing, which as I said, is very important for me.

I really don’t like the idea of the Nissen Fundoplication. It seems to me to be time limited and too risky. I found too many horror stories and of necessary repeated surgeries. Also, there are no really experienced doctors with this procedure where I live. A surgeon told me that in order for someone to count as experienced; they should be doctors that conduct this procedure several times a day for an extended period of time. For this problematic procedure, if a doctor did this procedure intermittently, only several times a year that does not make him count as experienced.

I am hopeful that the esophyx will be improved enough to be safe and long-lasting. I live in Israel. about half a year ago they did try this procedure in Israel with the aid of a French expert which was a representative of the esophyx company. Unfortunately, after speaking with the doctors who participated, I learned that both operations were not successful in reducing the symptoms of the patients, in spite of the fact that the actual procedure did go well. This is very discouraging of course. I found many positive statistics published by the company itself, but hardly any signs of happy customers testifying for themselves about the success of their experience with the operation.

There is also a company in Israel called Medigus that is developing a similar product, but it looks as if it is a method for applying a single stitch, where as the esophyx is used to insert several stitches. It seems to me to be better to have several.

Here are a couple thoughts for which I hope to hear some of your replies:

I wonder why they don’t insert some sort of ring to strengthen the sphincter, like they do for weight loss surgery. If the problem is that it is week, a complete ring would make it really strong wouldn’t it? It could even be a ring that can be perhaps mechanically constricted or released as necessary.

The esophyx is a method of performing several stitches that are each independent of the others. Perhaps if they were connected or fastened to each other it would increase the strength of the resulting barrier.


If the problem is that the barrier needs to remain somewhat flexible, maybe they could create two rows of double stitches so that there would be some sort of overlap between them like so:
___....___....___
....___....___....___

That way they would be stronger then independent stitches by still leave room for movement between them.

I’m just shooting in the dark here and writing these things because I am so desperate and am trying to learn this subject as much as I can.

Thanks for reading
Gilad

Hi Gilad,
First allow me to tell you that the internet is a bitter sweet tool.Sometimes the majority of documentation you see is failed cases on the nissan. thats becuz most successful stories are people who went on with their lives and have no need to surf the net for remedies.
well with the nissan fundoplication it strengthens your LES vavlve. The fundus is wrapped around the valve and stitched making it tighter. Its like when u button your shirt.The button is in the button slit. As for the esophyx, their are certain requirements for this. If you have a weak lower esphagus sphincter to my knowledge this will not be successful nor will you be considered a candatate.

I had the nissan done on may 7th 2009.I am a new woman.I have a thread of posts going on .It documents my pre op and post op. I have a life now.No asthma, chest pains, throat inflammation etc etc. I decided to stay with healing well and document "My story" as I seemed to be doing well.
The only way for this surgery to be successful is having a skilled surgeon.At least he shud have a 100 or mor of the nissans under his belt. Also, my surgeon used whats called a "Bougie" so the wrap wudnt be too tight.
Take care and if u like u can email me,just click on the envelope to the left in 1st column.
Thanx
Bea

Hi guys a bougie is sorta like a little tube that they put next to the esphagus when they are ready to do the wrap. they wrap the stomach around the bougie then remove the tube . This is so your wrap isnt too tight. I had a HH a weak LEs defective !! If u go look at my thread on my post op u will see all my prior ailments.It also states when I ate what I ate etc etc. I am healed now.Its been 2 months . I am so much better now.

Joy -
I have the same issues with doctors and I was "officially" diagnosed with "white coat syndrome" by the anesthesiologist who saw me for my pre surgical visit for my Nissen redo. She even wrote it in my records and said they won't check my blood pressure right away when I returned for surgery, but would wait 30 minutes so it would be lower. I didn't believe her, but they actually did wait 30 minutes after I got changed and stuff before they checked it.
I am 11 days behind Bea on healing from my Nissen redo and things are actually going pretty well. I can eat anything I want already. The first time I had issues with food getting stuck until I had the redo May 18th this year.

Take care,
Bill

Im sorry gilad here is what I meant to write.

The EsophyX procedure treats GERD transorally (through the mouth). It improves reflux symptoms more effectively than anti-acid medications, and enables many patients to stop taking anti-acid medications altogether. No incisions are required and recovery is even faster than the laparoscopic fundoplication. The EsophyX procedure reinforces the gastroesophageal junction by folding (plicating) the upper portion of the stomach (the fundus) around the gastroesophageal junction for about 270 degrees and securing it in place by special fasteners. It is based on the same principles that have been shown to be effective in the Nissen fundoplication. It is FDA approved and has been in use since 2006.   Benefits over Medical Therapy: The EsophyX procedure works better than medical therapy alone (e.g. Prilosec, Nexium, Protonix, etc.) in allowing patients to eat spicy, acidic, or other reflux-causing foods. EsophyX also enables more patients to exercise and sleep without reflux symptoms. Many patients are able to stop taking anti-acid medications altogether - which is important as Proton Pump Inhibitors (Nexium, Protonix, Prevacid, etc.) have been linked to osteoporosis. (Calcium is best absorbed when it has stomach acid around). EsophyX in Comparison to Laparoscopic Fundoplication: Even though a laparoscopic fundoplication offers a fairly rapid return to work (2-4 weeks) and physical activity (6 weeks), the EsophyX procedure offers a faster return to normal activity (1 week, often less), fewer operative risks and less postoperative pain. (Both procedures require a similar diet for the first weeks afterwards.) The EsophyX procedure seems to minimize, if not eliminate, symptoms of bloating, gas, diarrhea, and discomfort swallowing that occurs in about 5% of patients having a laparoscopic fundoplication. The EsophyX procedure is not designed for patients with moderate to large hiatal hernias, however; and its overall durability is probably less than that for a laparoscopic fundoplication. However, the Esophyx can be redone or a laparoscopic fundoplication can be performed if it stops working. Is EsophyX for Me? Patients with GastroEsophageal Reflux or Laryngeal Reflux may wish to consider the EsophyX procedure if: -increasing doses of medication are needed; or -patients are having to switch medications because one is not working; or -heartburn, reflux, or other GERD symptoms persist despite taking medication; or -upper airway or laryngeal symptoms are due to non-acid reflux; or -the patient is already at high risk for osteoporosis, In order to be a candidate for Esophyx, patients must have gastroesophageal reflux disease and a reducible hiatal hernia of 2 cm or less. We often confirm that a patient has GERD by a pH or impedance test. We assess hiatal hernia by a upper GI X-ray series and/or upper GI endoscopy. Patients with significant obesity (BMI >35), Barrett's esophagus, or signficant narrowing in the upper esophagus, are generally not candidates for the procedure

 I meant to write hiatial hernia guys .I dont know why I wrote LES Valve.

Post Edited By Moderator (stkitt) : 7/19/2009 3:58:58 PM (GMT-6)

Hi again,
A long time has passed since I posted this topic.

I am still trying to keep updated about this and other procedures.
Unfortunately a somewhat discouraging research publication has recently come out (NOVEMBER 5, 2011) that does not show the Esophyx to be a great success:

http://jsurg.com/blog/comprehensive-evaluation-of-endoscopic-fundoplication-using-the-esophyxtm-device/

This is their conclusion taken from the end of the abstract:

"at 6 months...the majority of patients did not experience normalization of their pH studies and remained on PPI therapy. The procedure has an acceptable safety profile, but the question remains as to whether it is effective enough to warrant a place in the armamentarium for the treatment of GERD."


I still hope other studies will prove more promising. So far the only promising evidence comes from the company itself or from claims of clinics performing this procedure.

I will keep hoping though for some sort of viable solution. Maybe they will be able to improve this procedure to be more effective. After all it is still very new.

I had the TIF in April. My first pH test had a DeMeester score of 28. I had a pH test 4 months after my TIF and my DeMeester score was 5.8. I can tell that my acid reflux is much better and I am off the PPIs. My surgeon has done about 60 TIFs and he seems pleased with the outcomes.

Trish - when you say the procedure was a failure, I am assuming you are saying that it did not stop your reflux. However, did it result in any complications?