choice of a surgeon

Hi Joe,

Did your GI doc recommend the local surgeon? I know that everyone has to start somewhere, and that there could be a skilled and gifted surgeon who could do wonderful Nissen procedures after very little experience.

That said, you'll find that most people here believe that there is a learning curve that comes with a great deal of experience. In addition, your choice of the best surgeon--experienced in the specific procedure involved in a Nissen surgery--is the most important decision you will make. An excellent, experienced surgeon is probably the most important factor in insuring an excellent outcome.

Not knowing any more than what you've said, I would tend to go with the more experienced surgeon. Of course he will have some lawsuits in that time. Doing that many Nissens can place him in jeopardy, since this surgery is very touchy, and some have difficulty dealing with post-op discomforts such as bloating. If you do that many Nissens there are bound to be a few problems. If my math is right, that's just 3% sue rate, which doesn't sound very high.

Many surgeons don't do the surgery because it's so touchy. Once it went from an open procedure to a laproscopic procedure, it thinned out many of the surgeons who once did it. I've read that this was a very good thing, because it created a few supremely qualified and experienced Nissen surgeons.

I think once others post here, most will urge you to go to the surgeon who has done the most Nissen surgeries. I've heard that a surgeon needs to do 300+ surgeries to really have the procedure refined.

I know it's a pain to have to drive an hour and a half, but if it will make your Nissen more successful, it will be worth it. It sounds like you've researched the surgeon pretty thoroughly.

It'll be interesting to see what others post here.
Good luck with your decision!
Denise

I was told by my surgeon that the surgery is less than 30 minutes by a skilled surgeon. He's been doing them for years. In fact he was the first one in GA who did it laproscopically.

I say go with the expert.

Joe,
It's a good idea for your surgeon to give you liquid pain medicine. You won't need it much, but it feels good to have it. For some reason, my surgeon didn't get my desire for liquid. He gave me tablets--even though I'd started liquid in the hospital. I don't see what the big deal was. Even though theoretically I should be able to swallow the pill, if psychologically it bothered me to do so, they should have provided the liquid version.

Experienced people here told me to be sure and have liquid Motrin on hand. (I went with liquid Tylenol, because I hae a sensitive stomach) That way when your pain is not severe enough for the narcotic pain reliever (which tends to leave you feeling kind of sick feeling) you can switch to the liquid over the counter med.

I understand your concern. It's the same concern that kept me from getting the surgery when I needed it for my lungs. If only I'd had it done earlier, it would have been so much better. My lungs deteriorated so much that my coughing and steroid use complicated the success. That said, I'd have it again in a heartbeat. I will probably need a redo, due to the damage that was done by the steroids and coughing. Even with the issues I had, it worked great.

Good luck with your decision!
Denise

Any doc who's doing it in 30 minutes is either not being careful or not doing a thorough job. If they are not dissecting the esophagus down enough to get a good wrap it will just herniate back up through the diaphragm. If they chop along too fast they can damage or cut the vagus nerve branches that are hidden in the fat pads. Mine took 5 hours for one of the world's best surgeons with a well-trained team. (Of course I had a paraesophageal hernia to deal with - stomach stuck up in chest.)

2000 is not very many, just starting to develop a routine. 30 is not enough practice. Maybe 200 is not enough either.

Half a dozen lawsuits may or may not mean anything. Were they frivolous? Being unhappy with outcome may only mean the patients were not informed enough about what happens. It's not ALL perfect!

I'd go for a third opinion unless your GI doc says the 2000 doc has really good outcomes. I don't care if you have to go to another state. Don't settle for less than the best.

I've heard that the urge to cough after the surgery, especially for asthmatics is very strong. I also heard that coughing is a huge no no? Has anyone used Tussionex?

I had no urge to cough coming from my throat. It was all lungs. Try to get your lungs are in as good as possible shape for the surgery. so your coughing is minimized.