Hiatal Hernia and TIF or Linx Surgery

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NNCanada
New Member


Date Joined Jan 2012
Total Posts : 17
   Posted 1/1/2012 12:27 PM (GMT -7)   
Hey Everyone,

First I want to say that this is a great forum to talk about these issues. It is good to know you are not going through these issues by yourself. I have developed GERD relatively recently (about 6 months ago) and have done some research about the TIF and Linx surgery for GERD but both of them note that they surgery is done for people that have hiatal hernias that are small (i.e. >3 cm).

Based on a recent upper endoscopy, it was determined that my hiatal hernia is 5cm. Do you guys think it is possible to get the above surgeries down with a hiatal hernia with this size. Also would it be possible to get a hernia repair and then get the TIF or Linx surgery instead of the Nissen? The Nissen surgery seems to be a lot scarier than the other 2 options but it seems that a Nissen is preferred with larger hiatal hernias.

By the way I am not considering the surgeries right now but down the road

Thank you and any insight from more experienced form members would be appreciated.

imstarryeyed
Regular Member


Date Joined Nov 2011
Total Posts : 95
   Posted 1/1/2012 12:41 PM (GMT -7)   
NNCanada,

I can't answer your questions, but can only tell you of my experience. I was not suffering from reflux or heart burn but did have erosions in my stomach and esophagus. I also have asthma and severe anemia caused from the hernia. I was taking iron twice a day to get anemia in check. My hernia was about 10 cm and the surgeon gave me no choice. He said I had to have the nissen and right away. Your situation may be completely different. I hadn't even heard of the nissen until a month before surgery and like I said, the surgeon gave me no alternative.

Good luck to you!
Starry

NNCanada
New Member


Date Joined Jan 2012
Total Posts : 17
   Posted 1/1/2012 2:03 PM (GMT -7)   
Thanks Starry,

My hiatal hernia is not that large at this point and I am not experiencing your issues but since I am only 30 years old I suspect/fear that my hernia will grow over time which will most likely lead to surgery down the road.

bcfromfl
Regular Member


Date Joined Nov 2011
Total Posts : 384
   Posted 1/1/2012 2:19 PM (GMT -7)   
I have had the TIF procedure. Unfortunately, with a hiatal hernia of 5cm, your only surgical option is a HH repair/Nissen, both done at the same time.

The problem with a HH larger than 2.5cm is that the surgical site won't stay "put" below the diaphragm. The TIF actually pulls the LES into the stomach slightly, and fastens it in place. With a larger aperture in the diaphragm as a result of a HH, the fundus would be prone to extending into the chest cavity, and perhaps even force a larger opening.

-Bruce

NNCanada
New Member


Date Joined Jan 2012
Total Posts : 17
   Posted 1/1/2012 2:44 PM (GMT -7)   
Hi bcfromfl,

Thanks for your input and I think your points make sense. I am must wondering if you can do the hh repair first and then do the TIF surgery or the Linx surgery or is the thought that there would be a high chance of reoccurance of the hh without the Nissen.

Thanks

Tandem Rider
Regular Member


Date Joined Jun 2011
Total Posts : 120
   Posted 1/1/2012 7:16 PM (GMT -7)   
I had a TIF in April of '11. My surgeon said that he would first look at my hiatal hernia and if it was too large he would repair the HH and then do the TIF. My HH was not that large and he did not have to repair it first.

bcfromfl
Regular Member


Date Joined Nov 2011
Total Posts : 384
   Posted 1/1/2012 7:43 PM (GMT -7)   
I could be wrong, but I believe as a "matter of course" while doing a Nissen, the surgeon will check the opening through the diaphragm and cinch it tight if necessary -- even if a hiatal hernia isn't necessarily diagnosed.

Once a significant hiatal hernia occurs, a patient is always at higher risk even with a repair.

-Bruce

Post Edited (bcfromfl) : 1/1/2012 6:47:02 PM (GMT-7)


couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 12641
   Posted 1/1/2012 8:16 PM (GMT -7)   
My surgeon said the same things, Bruce. If your HH is large the nissen is the way to go. Otherwise you risk having your stomach pulled up into your chest.

The nissen is not a bad surgery. I was scared to have it because I'd never had surgery before. I wanted the TIF or linx. My surgeon said he had stopped doing the TIF because there was so many complications going on with it at the time and the linx was still in trials.

After surgery I had five little cuts on my stomach. My stomach was tender naturally. I followed the diet carefully during recovery and limited my physical activities for six weeks. It's now been two years since my surgery and life is good. No more choking on acid and gunk. I can eat almost anything I want with no trouble.
I say go for the nissen.
Joy

stkitt
Forum Moderator


Date Joined Apr 2007
Total Posts : 32602
   Posted 1/2/2012 9:17 AM (GMT -7)   
Just for clarification, was your question "can you have the hh surgery first and then at a  later time have the TIF surgery or the Linx surgery ?"
 
Thanks,
Kitt
~~Kitt~~
Moderator: Anxiety, Osteoarthritis,
GERD/Heartburn and Heart/Cardiovascular Disease.

www.healingwell.com

"only as high as I reach can I grow, only as far as I seek can I go, only as deep as I look can I see, only as much as I dream can I be"

NNCanada
New Member


Date Joined Jan 2012
Total Posts : 17
   Posted 1/2/2012 9:33 AM (GMT -7)   
Thanks everyone for your responses.

Kitt - My question is whether a surgery can be performed where a hh repair is performed for a large hh followed by either a TIF or Linx procedure (so just one surgery for both procedures).

From what I have read it looks to me that when you have a hh, the route to go is hh followed by Nissen. My personal preference would be to have a surgery with hh repair and then a Linx procedure (both done at the same time). I know the Linx procedure is not available in the U.S. yet but when it becomes availble it seems to have a few advantages over Nissen, one of them being the fewer risk of side affects and the fact that it can be reversed.

Thank you

Post Edited (NNCanada) : 1/2/2012 8:41:00 AM (GMT-7)


stkitt
Forum Moderator


Date Joined Apr 2007
Total Posts : 32602
   Posted 1/2/2012 10:43 AM (GMT -7)   
 
Thanks for the clarification and I cannot find any info that indicates you can perform the HH and TIF procedures together.  I wish you the best and hope you find the right procedure for you.
 
Kindly,
 
Kitt

~~Kitt~~
Moderator: Anxiety, Osteoarthritis,
GERD/Heartburn and Heart/Cardiovascular Disease.

www.healingwell.com

"only as high as I reach can I grow, only as far as I seek can I go, only as deep as I look can I see, only as much as I dream can I be"

imstarryeyed
Regular Member


Date Joined Nov 2011
Total Posts : 95
   Posted 1/2/2012 11:12 AM (GMT -7)   
NNCanada,

I don't know the answer to your question but I will tell you what my surgeon said. Hernias tend to come back if just repaired. The nissen wrap helps to prevent that by reinforcing the area. I had a large paraesophageal hernia so that might make a difference.

Starry

NNCanada
New Member


Date Joined Jan 2012
Total Posts : 17
   Posted 1/3/2012 10:00 AM (GMT -7)   
Thanks for the comments everyone.

tiflady
New Member


Date Joined Jan 2012
Total Posts : 17
   Posted 1/4/2012 6:25 PM (GMT -7)   
Hello everyone!

I've been reading every post I can on here, and it is a wonderful forum. I had a TIF and a partial Nissen (it had a special name, this partial Nissen, but I can't recall what it was) on 12/23/11 and can relate to many of your experiences.

The diet is VERY hard, especially so during the holidays. I made a big mistake New Year's Eve and had a drink of alcohol, and paid for it with pain and what felt like a bad attack of reflux. That sleepless night was my own fault. I found that small amounts of food (1/2 cup) at a time, somewhat warm work the best. I can hardly wait for eggs -- i'm allergic to milk products and really want a protein source (allergic to soy, too). I can drink Coconut milk and the Silk brand is good, in case any of you out there have a similar problem.

Like Starry, I had big problems with absorption (iron and the B vitamins) despite aggressive therapy with vitamins; has anyone heard whether or not PPIs can interfere with vitamin absorption?

I have not much pain now, but I do have some increasing shoulder pain. It's good to know this will likely fade with time.

Anyway, I had a 4cm HH and low pressures in my LES; so, I had a partial Nissen wrap immediately (same time) followed by a TIF.

I also have other chronic conditions, including a blood clotting disorder, a thyroid disorder, degenerative disc problems and am bothered by constipation. Does anyone know if GERD and constipation go together???

Also, I am a runner, even though my conditions sometimes lay me up for a while. I'd be particularly interested in other wanna be or real athletes out there who try to remain active despite chronic conditions.

JB in Northern CA

imstarryeyed
Regular Member


Date Joined Nov 2011
Total Posts : 95
   Posted 1/4/2012 7:10 PM (GMT -7)   
Hi JB!

My surgeon told me the hernia was causing bleeding that my body absorbed, therefore not evident to me. I have never taken PPIs so they were not causing an absorption problem. B vitamin levels were normal. Although I didn't have heartburn or reflux I guess I had silent GERD.

I have never had a problem with constipation either, although with high doses of iron it would be expected. I am vegetarian which might account for something too.

I've been having shoulder pain too. It seems to be worse while lying down. Maybe the vegus nerve is being pulled. Not really sure.

Good luck to you in your recovery!
Starry
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