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Nissen Redo - Dr says they have to go through the chest! Help

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Posted 6/11/2013 7:45 PM (GMT 0)
Has anyone on here had to have a Nissen redo where the surgery is done through the side of the chest, under the arm?

I had my first Nissen done in 2002 laproscopically. But about 10 months ago my wrap came undone and my hernia is back. I saw the surgeon who did my initial wrap, and he says that the redo would have to be done through the chest. Said there is more of a concern with damaging the nerves of the stomach and esophagus if he does another lapro. Also said when its done though the chest, the chance of the wrap staying in place is higher.

I've tried to research a nissen wrap done though the chest, but I cant find anything on it. Anyone know what it is called or has anyone had it done? What are the risks? What was your recovery like? Any help would be much appreciated.
Posted 6/12/2013 12:13 AM (GMT 0)
Welcome to the forum, Rupert.

While I was in the hospital recovering from my surgery, I was in a room with a person who had surgery between the ribs, as you described. Not a happy camper.

I'd get a second opinion from a really big university group. There's one that does lap surgery to repair old ones in Pittsburgh. Your doctor is right about the concerns, but experienced surgeons, the kind that do several in a day, might take you on.

Look up words like thoracotomy or trans-thoracic re-do of fundoplication.

Post Edited (Alcie) : 6/11/2013 6:35:39 PM (GMT-6)

Posted 6/12/2013 3:38 AM (GMT 0)
lordrupert

I have had 2 redoes. 1 was done lap and one was done as an open surgery. I also have had a thoracotomy for an esophageal perforation. I raise the B flag and get a second opinion with a surgeon who specializes in redoes. My 1st redo was at Layola Medical Center teaching hospital and my last redo was done locally by a thoracic surgeon who did my lung surgery who normally does the thoracic nissen, but said my redo would be better done as an open due to scar tissue. This was 6 months after my thoracotomy.

As Alcie said check out a University if one is available, but you may have a very good surgeon near by who would do this open or lap.

Trust me, thoracic surgery is absolutely no fun. Most likely will have to deal with a chest tube. I've had 3 with my 2 thoracic surgeries. If I have to have another redo I am going to ask for an open surgery again. It was my easiest to recovery from. I did have to stay in the hospital for a few more days, but that also allowed for better pain control.

Again, any surgeon who says a redo can't be done lap or open is lying. I also am dealing with nerve damage on both sides in my ribs from my thoracic surgeries and were from 2 different surgeons along with ribs that won't reattach in the cartilage on my left side. They also have to deflate your lung to access the esophagus to do the redo, my left lung is permanently deminished from scar tissue from the last thoracic surgery.


I know this isn't great to hear, but I feel it is best to be fully informed before deciding on what way to go.

Take care,
Bill
Posted 6/13/2013 7:18 PM (GMT 0)
bump
Posted 6/13/2013 9:10 PM (GMT 0)
Thanks for the replies. My first surgery was done in 2002 by Guy Voeller of the UT Medical Group in Memphis, TN. He is supposed to be one of the top laparoscopic surgeons around. He is the one who mentioned that it would be done through the chest next. I am waiting on the consult with the Thoracic surgeon.

How dangerous is the thoracic approach; as in is there a greater chance of going wrong? What is involved with the chest tube? How long does it have to stay in? Did you also have to have an NG tube after the surgery? How long was recovery for you? When i had my lap done, I had a hard time with not being able to lift myself out of bed or sit up. Was thinking the thoracic might be a little easier to recover from in that regard.
Posted 6/14/2013 3:44 AM (GMT 0)
lordrupert


Well since they go through your ribs expect a lot more pain. The chest tube stays in until your lung will stay inflated and there is no longer a certain amount of drainage. I have nerve damage on both sides now from the 2 thoracotomies I had. The nerves run right along the top of your ribs and are very easily damaged.
I did have an NG tube after my thoracic surgeries. Usually you have to stay in the hospital longer for this surgery also.
I can't say if it's more dangerous or not, but thoracically they have to deflate your lung during the surgery to get in there. As I said before I now have diminished lung function on my left side from that thoracic surgery. I have had all three surgeries lap, open, and thoracic if I have a choice I will go with the open surgery then lap and lastly thoracic.
My 1st thoracic was a lap thoracic and that still was a bear when it came to pain.

My 1st redo was done lap after I had a lap nissen done incorrectly almost 3 years prior. That's how I know they can do redo lap without any problems. I would still be on that redo if they hadn't torn my esophagus during a routine EGD for barretts. The reason I had my last redo open was because it was only 6 months after my thoracic surgery to fix my esophagus and he knew there would be a lot of scarring.

I understand your surgeon is top notch, but him saying the only way is to do it thoracic isn't true and is the most painful route. The surgeon who did my last redo usually does them thoracic because he is first a thoracic surgeon and learned it that way 1st. He even told me that it is the most painful, but that's the type of surgery he does the most and is more comfortable doing it that way.

You will still have pain getting up, but will also have pain using the arm where they go through the ribs. It takes about 6 months or so for the ribs to reattach to the cartilage if the get dislodged.

I know I paint a nasty picture, but I do want you to hear the truth about this from someone who has had it done.

I would seek out a surgeon who specializes in nissen redoes.

Take care,
Bill
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