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Partial Fundiplication v tif-to pay or not to pay

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Posted 10/30/2013 8:40 PM (GMT 0)

Heartfelt thanks to all who post here-the decision to have surgery is BIG and it is extremely helpful to hear your stories.

For the past few years, I have woken up almost every night between 1-3 am with phlegm, sometime so much that it feels like I'm choking, pain/pressure in upper abdomen and bloating.  I occasionally but rarely have a burning sensation that I would call heartburn. This past summer started having throat clearing issues/shortness of breath while awake so had endoscopy which revealed small hiatal hernia and inflamed esophagus. GI put me on Dexilant which was ineffective and not tolerated well. She added Zantac 150 at night, still no improvement. Changed diet, minimal success (eat mostly healthy already) and had a tiny bit of relief raising head while sleeping but still waking up most nights. I had a successful laparoscopic colon resection in 04 (diverticulitis) and the surgeon happens also to be a GERD specialist so decided to see him-he only considers surgery after several torturous tests including barium swallow, HRIM, 24hr Impedance, TNE and the Bravo capsule (24 hr had shown no acid but the Bravo verified acid reflux.)  He is recommending surgery, says I am a good candidate for TIF but my insurance does not cover it. He thinks a partial fundoplication would provide equal relief, insurance covers it and I could have it done in December.  Would love to hear your thoughts, suggestions, etc. 

Posted 10/31/2013 12:57 AM (GMT 0)
Hello,

I'm not sure if you have read any of my previous posts, but I'll recap really quickly. I had the TIF in April. My surgeon said he cherry-picked TIF candidates and thought it would be a good choice for me. I was terrified of NF surgery, so I thought this was a good option at the time.

Earlier this month I had a gallbladder attack and ended up in the ER vomiting. They wouldn't give me anti-nausea meds until about 3 hours after my arrival, and in that time I destroyed the TIF.

So, two weeks after gallbladder removal, I had a nissen done. Recovery is going as expected and I do not seem to have any of the terrifying issues that we read about on the Internet thus far. I will say that after the TIF I could burp, and now I cannot, but it isn't really so bad. I really think the juncture between my stomach and esophagus is a lot stronger now than it was after the TIF. That's my two cents. Hope it helps in your decision making process.
Posted 10/31/2013 2:21 AM (GMT 0)
Thank you so much!  I really, really appreciate your reply and input.  Sounds like you have had a rough go of it, 3 surgeries, yikes.  So sorry you've been through so much this year.  That is awful that they didn't give you anti-nausea meds in the ER-aaarrrghhh!  Hope you are able to have them on hand now.  I have a very low tolerance for meds but have had great luck preventing nausea with Zofran both during and after procedures. 

Did you have a full or partial NF?  I have read a bit in the blogs and it is unclear as to whether the partial allows for burping and vomiting-the idea of not being able to do either scares me so it is comforting to hear that you find it to be not too bad.  My surgeon is recommending a 180 degree wrap-would love to hear from anyone who has had same.

Just curious-did your surgeon check your gallbladder prior to your TIF?  I know the attacks can come on suddenly but my surgeon wants me to undergo a stomach emptying test and another test to verify my gallbladder is not causing issues before surgery. He is very thorough but I'll be happy when the testing is done. 

Hope your recovery continues to go well!  

Barb

Posted 10/31/2013 1:43 PM (GMT 0)
Hi Barb,

I had a full NF. I think mine is tighter than most that my surgeon does. His PA told me that they were unable to dilate the wrap as they usually do because of the prior TIF. So I can't burp or vomit. Before I developed reflux, I burped very little, so in a way I am returning to normal. My body does seem to force out little burps occasionally though. Not being able to vomit worries me a little. I do have Zofran on hand now and intend to keep it that way. :-)

My surgeon did not check my gallbladder prior to my TIF. I went through the usual reflux testing (upper GI, endoscopy, pH test, manometry). I am 27 and had no prior health issues, so I think the assumption was made that I was otherwise fine. When I had the TIF in April, I hadn't had any attacks. Over the summer I had some stomach/abdominal pain that I assumed was gas related and there seemed to be no resolution except to wait it out. In about 8 hours or so, it would pass and I would be fine. Looking back, I think these may have been mild gallbladder attacks.

It sounds like you have a good surgeon who wants to be sure everything else is ruled out before any kind of procedure, which is fantastic. I hope you can get the testing over with soon and move on to a possible solution!

Stefanie
Posted 10/31/2013 3:23 PM (GMT 0)
Wow, Stefanie, you are young to be dealing with all this.  The more I read here, the more I'm convinced that the TIF may not be the best option. I'm seeing more than a few who have had to have a NF after a TIF so thinking perhaps it is best just to get the partial NF now.  Can't imagine having to do multiple GI surgeries in a year-feel for you.  How are you keeping weight on?   

I am 52 and other than my digestive system, super healthy but started having GI problems young. Inguinal hernia at age 18, diverticulitis in my 30's and now GERD/LPR in 50's.  I have seen in pets that if there is one issue within a system, there tend to be issues with different parts of the same system, wondering if this may be true for humans too.  At your age, no reason to suspect issues with your gallbladder so totally understandable but a heads up for us 'mature' folks to be sure to check every function of our GI system prior to having surgery.  Seems important to know if there are other vulnerable points that might be negatively impacted by the surgery.  

So grateful that you have shared your story-thank you. Sending healing thoughts and best wishes your way! 

Hope you have an easy, healing, happy Halloween.

Barb

 

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