Outpatient Nissen

Hello Cary,

In my research I read a case study on the New England Journal of Medicine about the Nissen being done as an outpatient procedure. From the outside, one could argue that because of the laparoscopic approach that it could be an outpatient procedure. As someone that has had the procedure done, I would disagree (and I'm sure others here might, too) that this is an outpatient procedure. My Nissen ended up taking 4.5 hours because of the degree of scarring and raw tissue around my esophagus as well as a couple of what are considered "routine" complications that needed additional intervention (torn gastric vessels and a collapsed lung from a small puncture). My surgeon is well versed in the Nissen procedure and as a thoracic surgeon, has done 1000's of these as well so I was very confident in his skills. Given my recovery, I stand by that statement.

That said, the thought of going home the same day as my "procedure" (who are we kidding, it's major abdominal surgery that involves realigning your digestive system...but what do I know) makes absolutely no sense to me. I was in the hospital for a total of 3 days and was out of work for a total of 4 weeks. I would argue strongly against returning to work 1 week later. Knowing how I felt, I wouldn't have wanted to go anywhere near my desk job as sitting up straight for extended periods of time was exhausting.

Regardless, I wish you all the best in your recovery. This forum was extremely useful to me in my recovery and as I was planning for the procedure. Ask as many questions as you want...that's what us folks that have lived through it are here for!

-TonyG-

I personally think you need at the very least an overnight stay at the hospital. I spent two nights and was thankful for it.

I also took 3 weeks off of work and thought I could have used one more. Some people are fine going back to desk jobs sooner, like at 2 weeks, but really you are at max swelling then and its hard to get enough to eat to stay focused. I was sooooo tired and run down I could have never dreamed even trying to work half days at 2 weeks out.

Outpatient? I'd get a second opinion. Also, the doctor can call the insurance and insist that due to your condition (find something) you will need at least an overnight stay.

Patients should not be treated like sheep, and we shouldn't act like them either.

WOW! Thanks all for you input. I am calling Dr. today with questions. I will ask for at least an overnight in hospital.

I am in Melbourne FL scheduled to get the NF 11/25 at Holmes Medical Center, Dr. Mark Fusco. I have a prescription for liquid Lortab. Do you agree the major complaint after wards it pain? Thanks for the tip about taking it before the NF.

I am a freelance technical writer and work a lot from home, my time is pretty flexible. I can pretend to be working when I'm not if necessary, but can't miss deadlines.

I rushed this up because I am in the group who's insurance got cancelled, but now I see it might be reinstated which would give me more time to prepare. I am totally ready for relief as I am belching food into my sinuses. (was treated for 2 years as allergies & sinus infections. I also have chronic cancer sores due to high acid.

THANKS Again for the great feedback, I feel more confident to advocate for myself now.

Hi Cary,

I will tell you this.  By the next morning, I couldn't WAIT to get out of the hospital, and was frustrated that my surgeon didn't come in until 10 AM.  Hospitals aren't the best places to recover, and when there are no complications, home is a better option.

That said, I'll tell you what I received at the hospital overnight:

1.  Advice from the night nurse to get up and walk whenever I went to the bathroom (which I did...walking laps around the hallways each time)...very good advice to take home with you.  It will help get the gas moving out, and reduces the pain in your shoulder (yes, shoulder pain...it's generally the worst of it).

2. IV pain meds in the beginning...probably liquids as well, since you won't get a lot via mouth  for a while, due to the immediate trauma of the surgery/anesthesia.  Still, you can sip on water and swallow it down.  The swallowing is a little strange and painful in the beginning, but it works.

3.  They switched me to oral pain meds the night before I went home to be sure that they were working, and they could adjust them before I left. You can just call from home if the pain meds aren't doing the trick.

4.  Just wondering if they'll give you a barium swallow test, before sending you home...I didn't get one, but there are a few here who had surgeons who require them before taking anything by mouth.  I was just wondering that if they send you home, it will be something they want to do.

5.  They brought me "no-no's" on my tray...caffeinated coffee, carbonated soda, and a straw (carbonation and straws introduced more air into your stomach and increases bloating)!  All not the best for early recovery eating/drinking. The only thing they brought that worked with lemon ice, which was yummy, and fine to eat.  At home, you'll obviously have more control of your eating/drinking choices.

Honestly, I do think it's fine to go home right afterward. Obviously, the only purpose of the overnight or several day hospitalization is if you have a complication.  You will have to self-monitor and call your surgeon's office day or night if you have a concern.  I'm sure they're expecting it, and if you're a responsible patient you will do that.  You know your body, and if something seems seriously out of whack, give them a call.  Don't hesitate to get back into the ER, either. 

If you read lots of posts here, you'll get an idea of what to expect, so you'll know if you're out of the norm.  This forum will be especially important to you in the first few days.  You'll be able to post your experience  and concerns, and other Nissen members here can share their thoughts about them.

Here's my early recovery journal.  In my case, I could have easily recovered the first night at home in more comfort than the hospital.  Just listen to the advice of others here.  Read, read, read, and prepare yourself completely.  You'll do fine.  Here's the link to my recovery journal:

https://www.healingwell.com/community/default.aspx?f=45&m=2183443

Good luck!

Denise

 

Thanks for your support and guidance Denise, much appreciated. Yes, I hear you loud & clear about the walking & intend to follow your advise. I walk my dog on the beach daily & she expects it so no slacking there.

All other points well taken, thx! I will be prepared with jello, tea & broth.

I did a barium swallow test a few weeks ago. It seems like an awful lot of drinking right after surgery.

I have been given a pager number to call immediately with any complications.

Thanks again all for sharing your experience and for your great suggestions.

Cary

CaryF-

I too am worried you won't have the barium swallow after surgery to be sure there are no leaks. I wasn't allowed to eat or drink anything until I had this done.

A procedure to me is something like an EGD, maybe a knee scope, but this IS major realigning of your stomach and such. Even o]if your insurance doesn't want you to be inpatient, if you have any issues that require you to be admitted that all changes. Anything from pain control to any major complications can cause the doctor to admit you.

I had a spinal cord stimulator implanted at the VA last Feb. and it was supposed to be an outpatient, but I was admitted for 4 days for pain control. So don't write off the possibility of being admitted if medically necessary.

If you have any issues that aren't addressed before you do go home, be you own advocate and make sure they give you all the answers you need.

Take care,
Bill