Reflux returns after 3 months post op nissen fundoplication

Hello -

I had a Laparascopic Nissen Fundoplication on 11/29/12. I am now 3 months post op. This is my second Nissen. My first was back in August of 1994 (I was only 17) and it went fairly well. My experience this time has not been great, to say the least.

about a week after my surgery I felt like I was having reflux again. My symptoms were the burning in my throat. I still continue to have that same feeling. It's a dry feeling at the back of my throat, yet feels like it's burning. When I saw my surgeon 3 weeks post op, he told me that was impossible. I finally called my surgeon two weeks ago to ask about the dry, burning sensation. The surgeon prescribed Carafate and I take this 4 times per day. It's been two weeks and I do not notice a difference. The burning sensation begins in the afternoon and continues until I go to bed. I don't get this feeling while I'm sleeping.

Does anyone know what this could be? I am losing hope at this point. I know many have said it takes months to recover from this surgery but I am not confident I will. My surgery in '94 was not like this at all.

I should also say that prior to my second surgery these were my symptoms also; the burning throat sensation.

I appreciate anyone's thoughts on this. I am starting to go crazy!

Sunny Sara

Thank you for the reply, drtinsac. I went to see my PCP a few days ago for an asthma flare-up and she prescribed prednisone for 5 days. After talking to her about my "feeling of reflux in my throat" she suggested I go back on Aciphex and see if it helps for a week. I'm giving it a shot but I think it will be hard to tell if it makes a difference because I'm currently on prednisone which drys my throat anyway. Something interesting is that I had a cold a few weeks ago and my "acid reflux" feeling didn't bother me at all during those two weeks. Why would it feel okay during that time? I wish I could go back to that!

I have not tried Elavil but certainly am up for anything to get rid of this feeling. I definitely think I have issues towards the end of the day because I'm tired and exhausted after a long day of work. I have lost hope that this issue will resolve itself. I've lost hope with my surgeon also when he says "it's impossible to have reflux after the Nissen." It didn't seem like a concern when I met with him a few months ago post op.

Thank you. I really appreciate the feedback.

Hi SunnySara,
Welcome to the Healing Well Wrapped Club! It's great to see that you've already gotten some wonderful advice from drtinsac. This forum is a great place to get information and support. I have my Nissen four years ago, and found the forum just before my surgery.

There is something you need to consider. This is your second Nissen, which automatically makes it more challenging to recover from. A redo is always much more challenging for the surgeon, and requires even more skill. Your original wrap was taken down and a new one was created. This is much harder on your body/GI tract than the first Nissen.

It's not a bit surprising that it is a more difficult recovery. It will just take time, but once you're healed you'll start noticing improvements. It takes a full six months for most of the healing and a year for the rest. The second six months is mainly adjustment to the changes.

Like you, I have asthma, which was the primary reason I had the surgery. Prednisone is very hard on the GI tract, so it's not ideal to be on them. They may be adding a little more stress to the mix.

I've been helping out on the forum since my surgery, and one thing has become apparent. At about the three month mark, people tend to start eating more aggressively. They may not chew as carefully, and they begin to introduce more challenging foods into their diet. This very often creates some pain/discomfort, and they come back with claims of reflux or fear of a failed wrap.

First, as far as typical "reflux" symptoms go...the esophagus is a dumb organ that interprets all pain as heartburn. If the esophagus gets irritated it will tell the brain that it has heartburn, even when that isn't the case. As drtinsac has so wisely said, the irritation that led you to the redo will take time to heal.

I don't think your doc is totally honest in saying that "reflux is impossible after surgery". From everything I've learned, it is certainly possible. If they were to get reflux to zero, the wrap would be so tight that you wouldn't be able to swallow. They just get it to "normal" levels. Prior to full healing, there can be some residual swelling of the wrap that can allow some reflux through. It seems to me that swelling from a redo might persist longer because there was more trauma to the area with the take-down.

Also remember that 18 years have passed since your first Nissen. I hate to tell you, but recovering at 17 is a whole lot easier than 35. You most likely have a lot more demands on your time now, and are busier, in addition to the fact that you're older.

So bottom line is...don't spend time worrying that your wrap has failed. Back off on your eating a bit for a couple weeks, to give yourself a chance to heal. Make sure that anything you eat is smooth before swallowing it. Baby your upper GI tract...it has been through a lot!

Glad you've joined the forum! It's a great place to be.
Happy healing!
Denise

Thank you, Denise for your reply and helpful info. I've tried to be patient and realize it's a longer recovery this time. Any advice on what foods to eat? What about trying Elavil? When do I contact my surgeon if its not getting better?

SunnySara said...
I am sorry to hear about the Elavil not working for you and waiting out the issues. The one thing that seems to bring some relief for a short time is drinking hot tea with honey. Seems to soothe the burning feeling.

I did not have these same issues with my first surgery. Things went quite well except for getting bread stuck after the first or second month and dealing with the flu. This time it feels different. Maybe it will be a longer recovery but it gets frustrating after awhile.

What does your surgeon say about your issues?

I have not talked to my surgeon about the issues. My 2 week follow-up appointment was with a NP who works closely with the surgeon. She said she didn't like the fact that I had a sour taste, and the first thing to do about it would be a barium swallow test. Since I find information online that many people experience sour taste and throat symptoms after reflux surgery, I'm not necessarily trusting that I'd get anything other than a barium swallow test if I raised concerns about my symptoms after surgery.

I am noticing improvement week to week.. if I had not been, I would have been bugging them already, but I know 6 weeks is still relatively early. Particularly for LPR, improvement can continue for over a year.

For some people who have burning sensation and try Elavil, they notice improvement within a few days. The same goes with other psych drugs used off label, such as Zyprexa (olanzapine) which I also tried before surgery with no effect. I'll probably wait a few more weeks to see how healing goes before I decide to try olanzapine again.

On another GERD forum (healthboards), someone recently posted that their LPR has been cured after 2 months of Elavil. The longest I ever took it was 5 weeks, though I didn't notice any improvement in that time. I've asked him some questions, like whether he noticed gradual improvement and how fast he noticed it. I'll try to come back and update when I find out what he said.

Post Edited (drtinsac) : 3/1/2013 7:23:38 PM (GMT-7)

Hi Dazza,

As I wrote in my post above;
The esophagus is a dumb organ that interprets all pain as heartburn. If the esophagus gets irritated it will tell the brain that it has heartburn, even when that isn't the case.

I don't know how long ago you had the 360, but if it was recent, that would add to healing time now. Your stomach has been traumatized by the reversal, and pain and "reflux" sensations are to be expected.

It takes 6 months for most of the healing and a year for the rest. Try to relax and be patient. Give your body the time it needs to heal. I understand your worries--they are very normal and pretty universal after this surgery. Try to hang in there and trust your body to heal and recover. It is way too early to make any judgements on the success of your procedure, but the odds are in your favor! It will get better with time and patience!

Hang in there!
Denise

Hi denise
Im not sure how they do the partial wraps because I can't see my surgeon for 8 weeks. Do you reckon acid might be going to my throat
From the swelling of the esophagus. Not sure if they staple the esophagus on a partial. Im scared of having a 3rd op

I would like more info on that. Sounds great

Thanx denise
I will give it a bit more time

Thank you for your response x

Timja:

Listen to your doctor, you are very early into your recovery and are expecting too much in a short period of time. Many people experience the same symptoms as you have, post-surgery, and they eventually subside. Most people do lose weight, initially, and then eventually gain it back. I drank a lot of protein smoothies, and followed the UPMC Post-Nissen Surgery diet. I did not start feeling much better until about the 6-month mark, and my "new normal" at approximately one year.

It's common to experience nausea after the surgery, ask you doctor for a prescription for anti-nausea medication. I take Zofran and I always carry it with me. I had surgery 3.5 years ago and I still periodically get waves of nausea for no reason. I did not have to take medication after surgery for the burning symptoms that you have, but everyone is different. Most people can tell you that the burning sensation is not the same as you experienced before surgery, and it will go away eventually. The sphincter is tightened, but not closed as you have to be able to swallow food. New normal to me means that after a year, I felt much better but am unable to belch or vomit, and there are still certain foods that I don't eat. I also gave up carbonation and alcohol, but it was just because I didn't like the gas that they caused.