Fundoplication Takedown

I had my fundoplication taken down in late 2014. Many people have asked if a fundoplication can be reversed. The answer is yes and I wanted to share my experience for the benefit of others. Here is my story but pleased be advised it is a historical recollection, not medical advice:

In 2003, I underwent a laparoscopic Nissen fundoplication. In retrospect, I was not a good candidate for surgery because my surgeon did not run most of the standard pre-operative tests to verify GERD and/or rule out other possible contributors. I also had failed PPI treatment which today is often considered a red flag not to pursue a fundoplication. [In the surgeon's defense, PPI failure was not viewed as a red flag against the operation at that time because PPI's were brand new and still in their infancy.] The fundoplication results were a failure to control GERD as well as new, devastating side effects from fundoplication.

We would later learn that I also sustained a modest injury to the vagus nerve during the operation which would result in permanent disability. I then suffered terribly for 11 years. In 2014, I began to rapidly lose weight and it became clear that I could not live with the operation. We were, however, concerned that I would be flooded with reflux if we took it down so we simulated a takedown by temporarily implanting an esophageal stent to push the operation off of the LES. The theory was that if the LES could manage in this environment, then it might be competent in a permanent takedown. [A stent is temporary and easily taken out. A takedown is permanent.] I had no heartburn or detectable reflux so we decided to takedown the fundoplication while I still could tolerate surgery.

In 2014, we did the takedown and did no reconstruction at all. We simply returned everything as close as we could to the preoperative state. I was seriously underweight by this point and we had to hurry because I would not be able to continue losing weight so quickly. The results of the takedown were profound. The takedown was laproscopic and went well. I was actually walking the streets of Seattle only two days after the reversal. [Albeit, slowly.]

Long-term, I have regained about twenty pounds and am a good weight. I am eating everyday and have no significant heartburn. [Just a little on occasion, but very minor.] I do not use PPI's at all. Many of the side-effects from the fundoplication have improved, although none completely improved. I can partially belch, but not completely. Gastric problems like gas bloat and loose stools only partially improved, so we manage the remaining symptoms with low dose opioids. I now have a manageable quality of life, but I want to be honest that I only made a partial recovery from the devastation that the fundoplication wrought.

Takedowns are inherently risky because of increased risk to the vagus nerve. We did find that my gastric transit speeds are much more delayed after the takedown than they were after the fundoplication, but I have found ways to live with that. The slowdown probably is related to the reversal but a perfect outcome on a takedown is not likely. Overall, I am profoundly happy with the reversal and feel taking the terrible fundoplication down was the best decision I ever made. I do not regret it and I try to live my life to the fullest.

So, if you're wondering if a fundoplication can be reversed; the short answer is 'yes.' Hopefully, my story will give you the insights you need to help guide your decision. I will warn people that taking down a fundoplication is fraught with risks. But, the rewards can be great. Godspeed everyone.