nissen fundoplication

Hi,

 

I have seen my surgeon who has looked through all my notes (test/symptoms) etc, and he has confirmed that I can have the Nissan Fundoplication surgery that will take place within the next 3 months.

 

I have already had an endoscopy; PH Manometry; 24 Hour Test; CT scan and my results confirm that my LES in weak and ineffective (the reading was 8? not sure exactly what this means).

 

My surgeon says that he can fix me from acid by the operation and I believe him and in fact want the Nissan - 'the sooner the better'.

 

However, he also has booked me in for a Barium Swallow and he says that this test is his base line and that this will not delay my impending operation. However, I do not know what he means by this test. As he agrees that I need the operation and that having looked at my history and notes etc. that I need the operation and can have this - then why do I need the Barium Swallow test? What does this test show? And will this change the outcome? I am concerned because I have suffered for over 4 years with acid reflux and pain (I have a hiatus hernia too) and the medication does not completely help.

 

If anyone can give me answers I will be very grateful.

Oh ok and thank you. Does it matter though to the surgeon's decission to operate? He has gone through the nissen procedure and has said that he is going on my history. It's just that I am simply a little nervous that he might change his mind - would he do this? My reflux is bad to me and the pills are not controlling this. The surgeon says that he will do a 360 wrap and pull the hernia back at the same time. Maybe I'm just being a little too anxious because I have already undergone several different investigations prior to getting this far. I was treated for a heart problem (suspected pericarditis) originally and this then led to the gastroenterology department and their tests that discovered my weak sphincter and hiatus hernia.

Thank you for any further advice given.

Hi Spike,
Glad you've joined us at Healing Well! The only question I would have is:
How experienced is your surgeon in doing Nissen fundoplication surgeries?

There are two main aspects in assuring that your surgery will be successful. One is making sure that you need the surgery, and that it's likely to help you. This is determined by the tests you have.

(By the way...if he's looking at the barium swallow as a "baseline", he probably wants a record of your hiatal hernia, and any reflux that the test shows. That way, after surgery, should you have trouble of any kind, he can compare pre and post tests to determine what to do.)

The second, and maybe the most important piece of the puzzle is the experience and expertise of your surgeon. Unfortunately, everyone is not equally experienced and skilled at this procedure. Since it's really an art form (the wrap must keep acid in, while allowing food to pass through), an inexperienced surgeon can create problems.

It is important that you ask your surgeon how many of these he has done, and what his results have been. You can make some calls, and check with GI offices to see who they recommend as the best surgeon in the area. Where I live, everyone pointed to the same surgeon, who has done over 1000 Nissen procedures.

Hope this information is helpful! Again, welcome!
Take care,
Denise

The doctor can't promise no more acid totally. Despite having no acid free days the majority of the time, if I eat peanuts or peanut butter I will burn and hurt.
You will have acid but it will be nothing like it is now.

The stress of waiting sometimes makes you feel worse. I remember the last month before the surgery my symptoms felt worse.

Hi Alcie, Thanks for your reply, my surgeon has already said that he will be doing a full 360 wrap and that the swallow was simply a base line. I suppose its' like you have said, a test to compare with the post op one.

Spike

Thank you Denise for your kind thoughts, I too hope my surgery date arrives very soon, I will let you all know as soon as I hear and meanwhile will keep reading through this forum.

Spike

Great, Spike! I know the feeling...once you've made the decision to move forward toward a better quality of life, you just want it to happen! That's not such a long time away...

So you'll need to ask any questions you still have regarding the surgery and recovery, so you'll be all ready to go.

Best wishes for a great surgery!
Denise

Here are a few liquid choices:
beef or chicken broth
gelatin
ensure, boost, muscle milk, or Slim fast (this a liquid protein drink)
any juice but grapefruit, orange, or tomato
applesauce
Popsicles
milk
vanilla pudding

Here are a few soft food choices:
Watery cream of wheat
watery corn grits (I don't know if you can get those in the UK?)
Vienna sausages (if you can't get them try Gerber's first foods mini sausages) these must be chewed to a fine mush and be sure to take tiny bites
puréed baby foods (I liked the sweet potatoes, stewed prunes, and mashed English peas, make sure to add a little butter and salt)
I was able to chew small bites of saltine crackers and let them dissolve into a mush in my mouth before swallowing.

If you can chew it into a liquid most foods are okay. But be careful of mashed potatoes, bread, rice, steak. These foods can swell and stick in your esophagus. One of the most important things to remember is to limit your meal size to no more than half a cup to 2/3 cup of food a meal. If you consume more than this you could suffer with stomach spasms or the food comes back up. :-(

Might there be a different name for what we call Jello? It's fruit flavored gelatin.

Hi Spike,
You're not missing much...Jello's not all that delicious. It just happens to be one of the "treats" you can actually eat when on a full liquid diet here in the US. Word has it that gelatin is made from some pretty nasty animal products, so you might just be glad you can't get it! It's very popular--especially among children. It's also an ingredient in all sorts of salad concoctions and dessert treats. College kids make it with alcohol and call them jello shots...

As far as post Nissen diet, it will depend on your surgeon. Some are sticklers about keeping you on a liquid or soft diet for weeks, while others (like mine) trust their patients to eat responsibly. After 5 days I was on any food that could be chewed to a liquid. That left the field open. The only caveat...no steak or bread (and obviously, no raw veggies or fruit...you just use your good judgment). Bread really gets clumpy when you eat it, and doesn't chew to a liquid. Toast on the other hand is just fine. You know when something chews to liquid. You can even test it out now.

I had prepared all these homemade broths, applesauce, squash, and had purchased Carnation Liquid Breakfast, in preparation for my post surgical eating. I only used them for the first five days (never, the liquid breakfast product), and threw most of them out.

A very comforting, protein filled soft food is egg custard. It's pretty easy to make, and is quite tasty.

I just took small bites and chewed to a liquid. It's so much more satisfying.

If you're anything like most patients, your stomach won't accept much in the beginning. It's swollen from the surgery and interprets that swelling as fullness.
A quarter to a third cup will be filling, so you'll be eating a little food all day. No big meals for a while.

Good luck with your surgery date!
Denise

I'm sending you my very best wishes for a quick and successful surgery, followed by a very positive recovery!
Just keep asking questions as they come to you.
Denise

Hi Spike,

I have just had my 2nd wrap - first wrap slipped, seems my surgeon wasn't all that brilliant, but as I was in the military and they were paying for it I couldn't choose my dr.

The 2nd one was done by a very experienced surgeon and other than some post-surgical shoulder pain (which you will probably experience due to the hernia repair) so far so good! The first 12 months after my initial surgery were probably the best 12 months of the past 10 years. I had no reflux/heartburn and felt great. I am hoping this repair will be better than the last, with better surgeon and better pre-surgery testing.

I found for the first 2 weeks I was limited to liquids only, so I survived on soups, frozen fruit ice blocks, jellies and custards - as long as they weren't too thick. I have found you can also have things like watermelon, pretty much anything you can disolve in your mouth works well. Pureed fruit can work too, so apple sauce and the like. just take it slow and wait a while between sips/mouthfulls

For the next two weeks you can start to eat thicker foods, a smooth mash potato works well, cup-of-soups with the small noodles - the extra liquids if you take small sips means the noodles wash down ok, just test the waters with a small sip and if it doesn't work, don't keep trying! Other foods that worked for me were soft vegetables, such as zuchini (cooked the way my nan does - so overcooked but very soft!).

Avoid carbohydrates, so breads, pastas, rice etc. The starch in these foods mean they will stick together and make it hard to swallow. I also find red meats the same. Chicken after 4 weeks isn't too bad, because you can shred it and take small bites. I don't eat fish, but I assume it is the same with fish.

chocolate melts in your mouth and as such is a liquid :) I ate chocolate the day I got out of hospital, i just sucked it until it melted, but I am addicted!!! Beer is also a liquid! Just trying to show you that it isn't the end of the world being restricted to liquids. Just take it easy and remember that you will struggle to eat normally for a few months potentially but the gain is worth it in the end.

Neither surgeon mentioned shoulder pain to me prior to surgery, apparently it isn't all that common, but can happen, particularly when the wrap has an associated hernia repair, so if this happens don't do what I did first time around and ask the post-op nurses if the surgeon operated on the right place! The surgeon also advised me to try to avoid throwing up. So if you feel the urge to upchuck tell someone, I was on anti-nausea injections for 2 days to ensure that it all stayed put. The strain that the body puts on the wrap with nausea is quite great and is a big risk.

Above all enjoy the new you! don't be surprised if you can't exercise for a while, just take it easy it will get better. most people don't require a revision of the wrap, I think only 2%. so if you have a good surgeon first time around and don't push things you will feel much better for it.

Kat