Testing before Nissen

I am scheduled for surgery for a giant paraesophageal hernia this coming Wednesday at UPMC. This surgery usually includes a Nissen fundoplication. Yet I have not had a manometry test or 24 hour pH Probe. Does that sound right to you all?

Hi cuicui,

With a hernia like yours, they don't need to know how much you're refluxing to determine whether or not surgery is required.  It's a critical situation and there is no doubt.  Therefore, the PH monitoring is a moot point.

The manometry is another issue.  Since they're likely doing a Nissen, it seems like they'd want to know your swallowing abilities.  However, they may be planning a partial or loose wrap anyway, in which case that wouldn't matter either.  The manometry determines whether or not your swallowing reflex is organized and strong enough to get food through a full wrap, which is tighter.

My guess is that's the reason, but you could ask.  It makes sense to me!

Good luck with your surgery!  We'll be waiting to welcome you to the Wrapped Club if you get one! 

Best wishes,

Denise

The patient's preoperative evaluation of a patient  with a giant paraesophageal hernia (includes a barium esophagram and upper endoscopy. A 24-hour esophageal pH study and/or esophageal manometry is obtained in some cases. It may be difficult or dangerous to instrument the esophagus so pH or manometry studies are frequently omitted. Endoscopy is usually performed at the time of surgery. If it is difficult to enter the stomach the scope is left in the esophagus until after the stomach has been reduced back into the abdomen. It is then easy to perform intraoperative endoscopy to evaluate the esophagus and stomach for pathology before proceeding with the repair.

Remember each person is different and I feel it would be wise to call your surgeon re your concerns.  Do be your own best advocte and we will be your cheering squad.

Wishing your the best with your surgery.

Kindly,

Kitt