Post-op lap nissen fundo/hiatal hernia repair

Barbara: I hope your recovery goes well---and you have good news to tell us after you are feeling better!

Hey Barbara... I am glad to hear that the surgery is over for you! Good Job on that, right? I am sorry to hear that you are at the moment not feeling amazing, but you are right, recovery takes time. I do hope you will pop in from time to time and let us know how you are doing. I pray you have an easy and speedy recovery. Do let us know how it goes. For right now, take it easy, and rest, OK hun...and let us know if you need anything...even if you just need to vent about how you are feeling...we are here for ya! Wishing you the best.

I had a laproscopic Nissen Fundoplasty recently. Mine was 10/22/07. I'm in my mid-40's. I must say that I've read lots of horror stories regarding the procedure. I cannot add to the bad stories. This may be a lengthy posting, but for anyone considering the procedure or who have had it recently I know you want details of a good outcome. You're probably looking for recent info and not items posted back in 2001 - which is mostly what I found when I was looking for information.

It's been a week and I am thrilled with my decision. The surgeon I chose has not done many of these procedures; however, I had him as a surgeon for another procedure last year and I trust him completely. He had a collegue who has done several fundo's assist him. For the first time in over 10 years I can lay down flat! I can sleep on my husband's shoulder without GERD symptoms in my throat. I may be eating mush now, but in a few months life will be grand! I can burp - some people cannot after the procedure. I'll find out at some point if I can or cannot vomit, but I'm prepared to not be able to. If I can it's an added bonus. My surgeon did not put me on anti-nauseau medication as a precaution against vomiting after the surgery.

According to an endoscopy, I had a large hiatal hernia and my esophagus was damaged, but I had not reached Barrett's yet. Up till last spring, I had been taking Protonix once a day. Medication was not something I wanted to continue nor did I want the yearly fight with the insurance company who thought Prilosec OTC was just as good as prescription strength PPI's. Everything caused GERD symptoms even while on medication - even a glass of water. A plate of spaghetti and sauce was the same as eating nails and tacks. Sitting up in bed was the only way to attempt to sleep. Some nights the chest pain was so bad I'd walk the floors wondering if it was an esophageal spasm or heart attack. I'd sometimes attempt to lie down on my side, but would wake up choking on "stuff" that had come up the esophagus while I slept and then I breathed it in. My surgeon and gastroenterologist consulted together for the past 7 months working up to this surgery. I had a manometry and 24-hr ph study last spring - I had it done after going off meds to give the doctors a baseline of what my true acid production was. The results showed I had LOTS of acid and poor motility in the esophagus. So I worked with the gastroenterologist over the summer and changed meds and doses. I also had a breath test done that showed the long-term use of PPI's had killed stomach acid and allowed an overgrowth of bacteria in my intestines - this was cleared up by a week of an antibiotic (by the way, the symptoms of bacterial overgrowth mimick lactose intolerance - once the bacteria problem was fixed I could enjoy dairy products, including a full glass of milk, like I hadn't been able to in several years). That added to my determination to have the surgery - I wanted my own stomach acid to kill bad bacteria before it gets to the intestines like it was meant to do. In order to prepare for another set of tests before the surgery, I started to take Nexium twice a day for the rest of the summer. I had another 24-hr ph and another manometry test. The mega-doses of Nexium had worked to prevent acid. Without the acid damaging my esophagus, they could see that the motility problem had been caused by the acid. This meant I was a good candidate for a full Nissen wrap.

I have had no medication for acid since Sunday, 10/21/07 and I've had no reflux. In the past, 2 days without medication put me in agony. The steri-strips should fall off the 5 incisions soon and the incisions give little discomfort - unless I move in a way that allows something to press on my abdomen. I was able to burp the day after surgery. I started on ice chips the evening of surgery and the next morning began a liquid diet - jello, chicken broth, Italian ice, cranberry juice. In the hospital I received morphine intravenously. I stayed 2 nights in the hospital. Because of several medication allergies, I cannot take a lot of drugs - therefore, I've been on Tylenol extra-strength liquid since I came home from the hospital and that has been adequate. I eat nothing thicker than pudding and the surgeon told me to continue that for 4 weeks. I saw the surgeon at his office 8 days after surgery and will see him again next week. I crush my blood pressure pills (which is OK according to the pharmacist) and swallow them with runny instant mashed potatoes.

My surgeon explained what to expect before surgery and has answered all my questions - no surprises were handed to me. From what I've read in other postings, having good information is unusual. I've read many postings about people who did not expect to loose the ability to belch or vomit. I was concerned about the trouble breathing I experienced after the surgery, but the surgeon explained that to tighten the hiatal hernia, they put stitches in the diaphragm. Therefore, I'll have a bit of a problem taking deep breaths and talking until it heals (which for some reason my husband is happy about). He also explained that although I felt great the day after surgery and not as great a week later, it was because it takes a while for swelling to happen and then dissapate. He explained that I'd feel worse a week after surgery and then things would get better. This same scenario happened with a previous surgery where the swelling and discomfort were worse a week after the procedure than the day after; so I have no reason to doubt his word this time.

My advice to anyone anticipating the nissen procedure is to do it providing you've had the proper tests first. A good gastroenterologist will request the proper tests be performed before surgery - the 24-hr ph study and the motility test are biggies - extremely unpleasant, but well worth doing to ensure the best possible surgerical outcome. Do your research online, but remember that most people only post the bad, not the good outcomes. Afterwards, have patience with your recovery. You've altered your stomach size and shape and your internal organs were moved around a bit during the procedure. Expect to be on a liquid or soft diet for a while as you heal. Give your tummy a chance to heal and give it easy-to-swallow and digest foods. Stay away from carbonation and any gassy foods for a while. If you have a hiatal hernia repaired, keep in mind that a large opening has just been made smaller. Expect some discomfort when you breath deeply. They pump you full of gas during the procedure, so you'll have a few days of internal pain as the gas dissipates (usually around your shoulders) - you'll also be very flatulent. Oh, and if you're a female, invest in one of those tank tops with a sports bra in it. You won't be wearing a regular bra for a while and "hanging around" gets uncomfortable after a few days.

I am thrilled with my choice to have this surgery; it was in the planning for several months and was worth the wait. I highly recommend it to anyone who's gastroenterologist says they are a good candidate for it.

Good luck if you are deciding. Good luck if you are recovering.

Thanks to all who have wished me well during my recovery.  It has been two weeks and my recovery is coming along but slowly.  I am still on a soft diet eating things like pudding, soup, jello, lentils, scrambled egg, cream of wheat, spagetti.  Thank God I haven't had any swallowing problems like choking but I am very careful and take small bites and take my time eating.  The soft diet is kind of hard to take for a while but it won't be like this forever.  My 5 incisions are healing but the biggest one still hurts a little, especially if I laugh, cough, or a have big sneeze. 

HappilyWrapped, I am glad you aren't having any problems.  I don't have any breathing pain but I still have chest pain.  I don't know if it is the wrap or the hiatal hernia repair (probably both).  I also still have nausea and take the anti-nausea pill.  The other day just this past Tuesday, I had really bad nausea and it lasted for about 2 hours and I was so scared I'd throw up but thank God I didn't.  I hope the nausea will eventually go away.  My surgeon said that anytime they operate on the stomach it really causes lots of trauma to it and it takes time for the stomach to recover from the trauma.  The pain that I feel in my middle of my chest and is like a dull ache.  Do you feel this type of ache?  Yes, I agree the test are awful but necessary to facilitate the surgery.  I will keep posting as I go along on my road to recovery.  Again, much thanks and kindness to all who were thinking of me...Barbara....

Hey there Barbara... So glad to hear you are coming along well with no complications! I know you aren't 100% yet, but you are getting there. I look forward to you posting more about your recovery. I think it's great that we have someone here who can talk about this procedure first hand for anyone who is thinking about doing it too. Thank you so much for sharing...keep us posted! Wishing you the best!

Barbara, hun, I hope you are doing well. Happily wrapped...welcome aboard, I am so thrilled you have been able to talk with Barbara the way you are. Amazing. Glad you found us. Let us know if you need anything!!! Again, welcome to healingwell

Yes, the chest pain is a dull ache and I haven't taken anymore painkillers in the last three days.  The pain is there and it does come and go but now it isn't as bad as it was and I just try to ignore it.  Luckily, I am not having problems with diarrhea but the nausea yes.  I was so happy because yesterday I didn't take the nausea pill all day but today I needed it around lunch time.  I have been eating some soft/solid foods but am being very careful.  Here is what I have consumed all day today.  For breakfast a very soft scrambled egg, lunch a chicken leg (chicken breast is too hard and chicken leg is softer) and 1/2 of a sweet potatoe (I take very very small bites and feel as if I chew 100 times before I swallow and am taking small sips of water as I swallow, jello, and for dinner I had a smoothie I made in the blender with ice cream, milk, banana, and strawberries, and had a small bit of homemade soup.  It is very hard because my appetite comes and goes and if you over eat you will get nauseated, so the key is to take very small bites, chew chew very good, and small portion sizes, and take your time eating slow.  At first, I could feel everything going down and it felt weird and it did hurt somewhat, even water.  I haven't had a choking incident but have been careful (thanks to Carla's advice).  I am hoping that eventually I will be able to eat like before the surgery but now I take very small bites and take my time. 

For Doghouse:  Yes, the manometry test are very important because it tells the surgeon how tight to do the nissen wrap because it checks for swallowing motility and also the pressure of the LES.  In my case, my swallowing was normal but my Les was a little off because the hiatal hernia was fairly close to the LES.  Since my hernia was a pretty good size and fairly close to the LES area that was why nothing ever worked.  The surgeon said what had saved my esophagus was the massive doses of PPI's I was taking.   I was on double doses of PPI and supplementing with 300 zantac at night and still I was burning up with heartburn.  I was so frustrated and had my gallbladder taken out 4 weeks prior to the nissen/hiatal hernia surgery and the gerd went over the roof.  I remember it was a Sat and Sun I couldn't do anything all day I had painful heartburn and no matter what I did it wouldn't subside.  I don't know if they recommend the surgery for esphoghitis (sp?) but the surgery is only the last resort when all other measures have failed and they will make you get all of these tests before they recommend the surgery, at least in my case.  I hope this answers your question.  Barbara....

Have either of you have had the wrap done gone back to work yet? If so, what kind of jobs do you have?

Doghouse:
I went to work this past Friday for 2 hours just to do some paperwork. I did not drive - I was dropped off and picked up. Most people didn't know I was there as I went straight to my office via a back door. I am an IT person on a school campus, so my job normally requires walking between buildings, up/down stairs, lifting computers and bending under desks. It also requires paperwork I can perform sitting at my desk. My surgery was 10/22 and Friday was just under 2 weeks post op. I was tired at the end of 2 hours and knew I could not go back full time yet. My surgeon does not want me to go back untill 11/12 and I agree with him. He also explained that because I was on the table for a little over 3 hours for the procedure, it would take at least 2 weeks for that much anesthesia to get out of my system - that means being extra tired for a while. I nap every afternoon for at least an hour and sleep 8-10 hours at night (my normal would be 7 hours).

I know enough to trust the surgeon's timeframe to go back to work because he's been correct before for other procedures I've had done by him. He knows better than I what's going on inside that I cannot see. So it will be no heavy lifting (nothing more than a gallon of milk) for 6 weeks and I'll go to work beginning on 11/12 and stay as long as I can until I get tired. Thanksgiving break will also give me a bit of time off.


Outlaw:
I have a co-worker whose husband had a full wrap over 10 years ago when they only did the procedure open (not laproscopic). He now leads a totally normal life and when seasick (on a fishing boat) he can vomit enough to get relief. He takes no meds and is happy he chose the procedure due to the improvement of quality of life. Because the procedure is still being tracked, there really isn't enough information gathered as to length of time. I read different results when I did some investigating online. I also have to remember that you don't read about good outcomes often - most people only write to complain.

Fundoplasty is not reversable. I obtained that information from internet research and my surgeon. They may have to go in and fix things for some people if it slips in the future. I am taking all precautions to follow instructions to ensure I heal properly and have less chance of slipping. This procedure has never been said to be 100% successful - anyone considering it needs to understand that it may or may not work for each individual and that there is no guaranteed time it will last. Enjoyment of whatever time I have acid free is my goal and if it isn't permanent, then I'm grateful for what time I get.

After surgery my activities are limited - not as much by the surgeon as by my own body. The surgeon only said no lifting. I do not carry a vacuum up or down stairs, but beginning 5 days after surgery, I did push it. We have a lightweight Oreck, so I was OK, but I could feel it pulling just a bit on my abdomen area depending on how I moved my arm to push it. I would never have touched the heavier vacuum we have. Washing dishes standing at the sink was OK. Reaching for something high in a cabinet was uncomfortable, so I didn't do it. I do laundry, but my husband carries the basket up and downstairs as well as lifts the laundry detergent to measure it. I've gone to the grocery store with my husband, but he lifts the bags; I walked and used the carriage as support when tired. Basically, my activities for the past two weeks have been light housework, reading, watching TV and a small bit of baking (because it's something I enjoy doing).

Movement is good to keep your plumbing working - you don't want to just sit or lay down all the time. However, you won't feel like doing much. You won't be lifting for a while. You won't be intimate with anyone for a few weeks. You won't be getting a bear hug for a while. I will start driving again next week - I was avoiding it because of the incisions. In the passenger seat I placed a folded bath towel between me and the shoulder belt. Moving my right leg to drive would have pulled on the incisions if I started too soon. Again, each person is different as to how fast they heal.

Because the incision areas are a bit sensitive, I've been wearing yoga pants rolled down under my belly button and an oversized sweat shirt. Material rubbing on the incisions was uncomfortable. Not being dressed properly prohibited me from going too far away from home. I am just today able to wear a pair of loose pants zipped up where they belong, but a stiff denim would be uncomfortable. Your tummy will be bloated for at least two weeks - it will go down during that time, but don't expect your pants to fit right after the procedure. Only each individual will know what they can tolerate, but the standard guidelines would be no heavy lifting for several weeks and just a bit of walking to stay active. Six weeks after the surgery, I'll be fine for all normal activity. Because computers and the old CRT monitors are so big and heavy, I'll probably refrain from lifting them for a while longer. As I'm a girl and work with several guys, it's no big deal for them to handle the heavy lifting.

snakelover:

This procedure is not for everyone. The only way to know if it's right for you is to work with a really good gastroenterologist if your symptoms are bad and/or are not controlled by daily medication. There are some people who have naturally weak motility (muscle movements that propell food down your esophagus and into your stomach). Those people are not good candidates for the surgery as it would impair their ability to swallow food permanently. For those whose motility is weak because of acid damage, the surgery is a good option because it keeps acid in the stomach where it belongs thus allowing the esphagus to remain healthy and able to move food the way it was intended to do.

Age does not affect the ability to have this surgery; it is performed on young children who have medical issues which require their lower esophageal sphincter to be reinforced.

yeah thanks so much for the info!

Barbara,

If you like mac & cheese, you could probably eat that now and oatmeal too. Just go slow like you are doing and it will slide down. You start to get tired of the few things you can eat. If you just keep doing what you are doing, I think you are going to have a great result.  I think I told you the first time you go out to eat, try ordering lasagna or spaghetti, they will both slide down if you take small bites.  Keep us posted.  I am so, so happy you haven't had anything stuck.  Just remember if it should happen, do not try to throw it back up.  Just be calm and it will move on down.

Take care!

Carla