GERD surgery questions

Hello Jill, and welcome to the forum!

This is a great place to get your questions answered, so you've done well so far in finding this forum. I had the Nissen procedure done back in April after being on a mix of various ppis (Protonix 4x's a day in the end) over 15 years that just weren't working anymore.

There are 4 critical tests that your surgeon should recommend. First, you've already had the endoscopy. Second, would be the manometry. There is also a 24 hr ph study and barium swallow that should be ordered at some point.

The worst part of the manometry test is getting the sensor placed. It goes up your nose and down the back of your throat down your esophagus into the top of your stomach. That process is slow and tedious, and yes you'll gag a little and your eyes will water. Once it's in place, it's not entirely uncomfortable. The test itself doesn't take much time. You'll swallow a bit of water to get the readings during the manometry.

Almost a year later post-surgery and I'm feeling fantastic. No more reflux or heartburn, and I can eat anything I want. The recovery is long and at times you'll feel worse than you did before surgery, but that's just part of the healing process. Your diet will be mostly liquids in the first few weeks after surgery and your activity will be limited as you heal. The key to a successful recovery is to listen to your body and not to try and push it faster than you need to. Meal planning and having someone to help you the first week or so will be essential. I was out of work for six weeks. Some people will say they went back to work after 2 or 3 weeks. Personally, I think that's too soon. Thinking about how I felt at that point, I wouldn't have been able to tolerate sitting at a desk all day after three weeks post-op. Walking around and keeping active (within limits) while you recover will help move the swelling around and accelerate your healing. You'll feel better sitting up or slightly reclined for the first couple weeks. Sleeping laying down will be uncomfortable in certain positions until the incisions heal. You may feel some shoulder and arm pain for a bit (I didn't) due to the air used to insufflate your belly during surgery. This is normal and shouldn't cause any alarm. Walking will help eliminate this sooner than later.

The biggest challenge will be your diet post-surgery. Take a look through many of the journals here as there have been good and bad experiences with certain foods. In the beginning it'll be hard to tell if you're hungry or not and you'll get full quick. Most importantly, you'll need to absolutely keep hydrated. Have water (or sports drinks if you like them) handy and drink often. Cold drinks will cause some irritation at the wrap site, so it's best to have room temperature drinks. Warm green tea was my best friend. If you don't keep hydrated, you'll feel worse and will have zero energy. Advancing your diet too quickly will be the worst thing you can do. Your doctor will advise you of a diet plan but this forum is a great place to find what worked best for people. Again, don't advance your diet too soon. I can't stress this enough. Food might feel like it gets stuck in the beginning, but that's because of the swelling around the wrap site. Take small bites, and chew thoroughly. A small sip of warm liquid will help food go down.

You'll have up and down days during your recovery, for sure. It's important to remain positive and try and stay active. Laying in bed or on the couch all day long without any activity will cause you feel worse. Even if it's just a short sprint around your house will be good. A walk up and down the sidewalk for a few minutes will be even better.

Hope this helps give you a little bit of insight. Feel free to ask as many questions as you'd like!

Take care and be well,
-TonyG-

Those tests are pretty routing. I'd be surprised if he doesn't. Perhaps he will after the results of the manometry come back. The 24 hr pH study is NO fun at all. You're basically wearing the manometry probe for 24 hours, recording when you have symptoms. I certainly would say that if you don't have the pH study done, that you wouldn't be missing anything ;) The barium swallow will look for a hiatal hernia and any other structural abnormalities with the esophageal sphincter mechanics. If your doctor isn't concerned with that, then he may not order it.

Like TonyG I had my surgery to repair a Hiatal Hernia and do a Nissen Fundoplication almost a year ago--last March. Although I worried for months in advance, none of my worries came to pass. Overall it turned out pretty Vanilla. The surgery took three hours, two hours in the recovery room and then two days in the hospital. I honestly had no ill effects from the surgery. I had no bleeding from the sutures (they used Glue to hold them together); I had no pain except for the gas pain in my shoulders and even that wasn't unbearable. I used the morphine dispenser while in the hospital mostly because the nurses told me to use it to stay ahead of the pain. I really didn't need it.

When I left the hospital they gave me two bottles of liquid Loritab for pain and an anti-nausea medicine but I didn't need either one. The first day at home I dozed and walked off-and-on all day. That night I took one dose of the Loritab to help me sleep--not for pain. Since that night I haven't take anything.

I was on a pureed food diet for two weeks. At my two week checkup I asked the Surgeon when I could begin playing tennis again. He told me "when I felt strong enough". So I waited another week and began hitting with a few of the guys just for exercise. Then I began playing again a few weeks later. I also began eating soft food at three weeks and within a month I was back eating small, frequent meals. I can now eat anything I ever ate but in smaller amounts than I did before--regular portions but no seconds.

Like many others, my main problem is abdominal gas. Shortly after I began eating solid food, I developed a way to burp. If I didn't, I would be in big trouble because like most others, I have a great amount of gas after eating. I am able to get rid of some through burping. The rest comes out the other end.

My only trouble comes from over-eating--holiday meals and/or buffets. On New Years we have open house and everybody brings a main dish and desserts. Since everybody arrives at different times, the meal drags out over a long period of time. So I got progressively fuller without realizing it. The pressure built up until I was miserable. The same thing happened today at a Casino buffet. Strangely, the pressure in my stomach seems to effect the Vagus nerve because I get extreme pressure-pain in the sides of my neck. That is the only explaination I can think of for the discomfort because I know that the Vagus has branches on both sides of the neck and that is where the discomfort is most noticable.

I hope your problems are as few as mine and you have a complete recovery.

Hi Jill,

Welcome to Healing Well! I see you've already met some of our great members who've shared their experiences with you!

I think your surgeon probably doesn't think the 24 hour PH monitor isn't necessary, since it's obvious that you have significant reflux, judging from your damaged esophageal tissue. The manometry is very important, as it will ensure that the wrap your surgeon creates matches your swallowing abilities.

Here is a link to my early recovery journal. Hopefully it'll provide you with some helpful insights about the recovery. I had lung issues, so just disregard that part.
www.healingwell.com/community/default.aspx?f=45&m=2183443

My surgeon told me I wouldn't be able to burp or vomit, and as it turns out, I can do both. I've had 3 stomach bugs in my four years post-op. Each time I vomited once, then began using the anti-nausea suppository, Compazine, to stop me from a repeat performance. You will want to avoid retching and vomiting--especially during your early recovery. Be sure to ask your surgeon or PCP for anti-nausea drugs to have on hand, just in case. I carry them with me wherever I go.

As far as burping...my stomach burps itself. I don't have a lot of control over it, but they are welcome when they come. I started little burps right away, and now I can burp some pretty big ones at times!

Good luck with your research and decisions! Stick around...this is a great place for answers and support.

Best wishes,
Denise

I forgot to mention my Manometry story. I am retired military so everything was done in an Air Force hospital which is a teaching facility. I had the barium swallow, the upper GI and the operation was already pretty much decide on. However they were required to do the manometry. So I was scheduled. I went in and everything want perfectly. The tube with the sensors went down without a hitch and minimum discomfort. When it was down the technician had to keep fishing it around before he could get what he thought was the right position. Then he did the test by giving me sips of water to swallow. It only takes a few minutes to do the test and then I went home. The next morning I got a call that they had to redo the test. The Gastroenterologist didn't believe the results so he conducted the next test himself. Because I had a large Hiatal Hernia, he believed that the tube went down and when it reached the hernia it curved around and started back up. So he had the entire Gastro staff watch the next test while he did it......nothing went right. I retched the whole time in front of all those people and again the tube tried to curve around and come back up. He was able to make the necessary corrections and that time it went ok as far as the results. Since you don't have the hernia you should have no problems....

I keep going back and re-reading all these stories and my anxiety wishes my surgery date will hurry up and get here so I can get some relief!!!

Thankyou very much for the positive input Iamgranny. Makes me wish i was having the surgery tomorrow. Im getting tired of frantically sitting up in the middle of the night bc my reflux is so bad.

Ya i sleep on several pillows. but still find myself getting up to go for the acid reducers whether its tums, pepto or alka seltzer at least once in the night. Im also careful not to eat anything just before bed... atleast an hour or two before. I think mine has gotten extremely worse since seeing the GI doc due to the fact my anxiety and stress levels have doubled bc of all of the tests and upcoming surgery. He wrote me for Ativan for my IBS which has also gotten worse as well. The anxiety meds do work for both things for me i do believe. I only take it on high stressed days though bc if i take it too often it will zombie me out and i dont like that feeling. I think once I get thru the Manometry study things will get a bit better (thats on Wednesday).

If any of you would like to stay in closer contact with me throughout my surgery journey just let me know and i will send you my email address. i dont mind. id love to have someone who i can actually relate with and talk to on a personal level with. and have someone to come talk to about my questions and fears.

Jill-

A couple tips to get through the Manometry easier is to either hold your tongue to the roof of your mouth or hold the tip with your teeth right after you do the swallow. This keeps you from double swallowing and having to do an extra swallow. They need 10 good single swallows to see what your esophagus is doing.

Also tucking your chin to your chest and swallowing hard while they are inserting the probe helps it go down easier.

Take care,
Bill

Hi Jill,

I am 7 weeks post NF surgery. In my case the 48 hour Bravo test was required by my insurance provider BCBS. It is a good measure of acid reflux & convinced me I was overdue for the surgery. My GERD complaints were: shortness of breath, loss of voice & voice/breathing control, bloating, belching (bellowing) regurgitation, chronic sinus infections, and severe coughing & choking with associated lovely mucous. I was taking 80MG Omeprazole daily, BCBS only paid for 40MG daily. Omeprazole is not cheap especially when looking at a life time of its cost.

All my symptoms have cleared EXCEPT for the coughing. It is measurably better, but I am back on PPIs. I hope it will improve more with time. I understand this is a common complaint.

Also in my case, as required by insurance company, I had the procedure performed outpatient, was in the hospital 2 hours. I returned to work 1 week post surgery (writer). My only regret is that I waited so long in the first place to schedule surgery, I am pleased with the result. Hope this helps you.

Cary