Nissan Fundoplication vs other proceedures?

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Minnesota Grandma
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Date Joined Mar 2010
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   Posted 3/3/2010 3:57 PM (GMT -6)   
I have had GERD for about 20 years. I am F, 58 years old and am about 40 lbs overweight. My GERD symptoms include heartburn, a cough, sore thoat, that thick feeling in the back of the throat that you can't clear, acid when I bend over, those episodes of mini "throw up", and during the last year, severe nasal and sinus congestion. I have had several endoscopies that confirm my acid reflux. Am Pre-Barretts and have a small hiatal hernia.
 
My surgeon is strongly suggesting that I have the Lap. full Nissan Fundoplication.
 
I am not so sure. I am going to try to lose some weight and he wants to see me in 3 months and do another endoscopy.
 
He assures me that the proceedure is quit improved and has good success.
 
 I do not like the idea of not being able to thow up. I wonder how often this proceedure has to be re-done; does it actually take care of Gerd for the rest of your life? How much gas does one have, if you cannot burp anymore?
 
I would like to hear from people who have had this proceedure or others for the treatment of Gerd. Good or Bad. I need help making a decision.
 
Thanks in advance to those who care.  Minnesota Grandma
 
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Thanks,
Kitt

Post Edited By Moderator (stkitt) : 3/4/2010 8:35:03 AM (GMT-7)


couchtater
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Date Joined Jul 2009
Total Posts : 14475
   Posted 3/3/2010 5:22 PM (GMT -6)   
I was one hundred pounds overweight when I had my surgery. I've lost 20 of them since the surgery.
Unfortunately, the gas does increase from the other end. :O
Beano helps with it some.
They give you antinausea meds to take when your ill to your stomach for the rest of your life to avoid throwing up. They work good.
If the surgery is done correctly and you avoid issues with it ...it is supposed to last for up to 20 years.

Joy

dencha
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Date Joined Feb 2009
Total Posts : 7188
   Posted 3/3/2010 9:04 PM (GMT -6)   
Hi Minnesota Grandma,
I had the laproscopic Nissen surgery about a year ago. My most severe symptom (aside from the heartburn/reflux issues and hernia) was uncontrolled asthma. The reflux was causing constant lung irritation. I was using far too much medication and steroids to keep me breathing. My doctors encouraged me to have the surgery, because it was a life-threatening situation. It took me four years to finally make the decision to go forward.

The surgery has been a godsend for me. My lungs are greatly improved. I do have concern that I may need a redo due to my heavy pre-surgery steroid usage which created very fragile internal tissue. This made it difficult for the surgeon to secure the hernia. The surgery made my health so much better that I wouldn't hesitate to redo it if necessary.

Not everyone who has the surgery has permanent bloating and gas issues. I may have a little more gas, but I am able to burp, which allows gas to escape. My burps are generally spontaneous. I'm not able to burp at will. I have anti nausea medications on hand always, in case I get sick. I actually had a stomach bug about a month ago, and found out I could throw up. My doctor did a loose wrap. I have had virtually no difficulty with swallowing (once past the early stages of recovery).

From what I've heard/read, the Nissen Fundloplication is the "gold standard" for repair of non-functioning LES/hernia repair. Other procedures are sometimes preferable for certain individuals, though. One of the tests you would get pre-surgery determines the strength and effectiveness of your swallowing reflex. People with less strong swallowing abilities may have a partial wrap, which will ensure less pressure is needed to get food through the wrap and into the stomach.

The recovery from the laproscopic procedure was a very pleasant surprise. I was expecting a much more difficult recovery. Every surgeon is different, but mine only had me on liquids in the hospital, sent me home the next day on soft foods, and after 5 days, after I'd seen him, told me I could eat anything that could be chewed to a liquid.

If you're ever interested, I could provide you with links that chronicle my recovery for probably the first 19 days. I am 57, so our ages are very similar.

I did a lot of research before having the surgery, and found the most important thing with this surgery is to have it done from an eminently qualified surgeon who had done many of the Nissen Fundoplication surgeries. Many excellent surgeons do not have enough experience in this specific surgery, and the outcomes can be very problematic. The success of your surgery will be dependent upon your surgeon's skill.

The surgery's longevity is variable, dependent upon the individual. I've heard of them lasting at least 20 years, others needing to be redone in a year, and everything in between. This forum was a godsend for me when I was trying to make the decision to have the surgery. I join them in feeling that although the surgery is far from perfect, it is worth the inconveniences to be relieved of the problems that the reflux has caused in my life.

Good luck in making your decision, and finding answers to your problems.
Take care,
Denise

looking good feeling bad
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Date Joined Mar 2010
Total Posts : 1
   Posted 3/3/2010 11:02 PM (GMT -6)   
I had this proceedure done, Can still burp. vomiting causes servere pain. Was thought to have a motility disorder due to an inability to swollow after the surgery.
I've had nothing but problems since having this surgery. I was hospitilized two days after surgery dehydrated, n/v and having chest pain. I never had a chance to eat or drank anything which could have caused my symptoms. a few months later I couldn't swollow water. Be very sure of your options before going this rout. I never had a choice. My doctor found and repaired my symptomless hernia which he found during lap banding. Never used the band but quickly lost 100 lbs my health and nearly my sanity. May God be wth you.

dencha
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Date Joined Feb 2009
Total Posts : 7188
   Posted 3/4/2010 7:39 AM (GMT -6)   
Minnesota Grandma,
Posts by individuals like Looking Good Feeling Bad are the ones that made me wait 4 years, and allow my lungs to grow progressively worse, until high doses of steroids created adrenal insufficiency. While I'm very sorry that Looking Good is having so many difficulties, and I don't doubt them, I would like to emphasize that those problems are not the usual outcome. You might think so if you look online, because you'll find many dissatisfied, damaged post surgical posters. Keep in mind that most people who have successful outcomes don't bother to get online and search out others who are having problems. The internet posts are skewed in the direction of poor outcomes.

I agree with Looking Good in the recommendation that you don't make this decision lightly. You MUST research surgeons in your area and fine out which one has a track record of good outcomes and lots of experience doing the procedure. You will not be restored to your youthful, pre-GERD condition. This surgery does create some GI inconveniences, and it takes a good year to be completely healed. Most of the healing takes place in the first couple of months, however.

This is a decision to be made by you, with the consultation of your doctors. It's not an easy one to make. You need to know that there are risks in any surgery. You can minimize those risks by researching and knowing what you're doing if you go forward.

There are many very happy post surgical patients.
Don't let those people with poor outcomes keep you from going forward if it's the right thing for YOU.
We're here to offer support and advice.
Denise

Looking Good...so sorry you're suffering. I hope you find a way to improve the results you've experienced. Hang in there. There's lots of support and encouragement for you here as well.
Take care,
Denise

Minnesota Grandma
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Date Joined Mar 2010
Total Posts : 12
   Posted 3/4/2010 10:14 AM (GMT -6)   
Denise,
 
Thank you for your information!
 
I also have had some periodic asthma like symptoms with the Gerd and had a breathing/pulmonary function test to make sure everything was ok.
 
My surgeon mentioned that in addition to stitching the opening in the hiatas when he repairs the hernia, he also adds mesh to reinforce and hopefully prevent a reoccurance and a second surgery. As you may need a repeat hernia repair, I thought I would mention that.
 
I have already had one test to try to determine how weak/strong my LES is. If I decide to have the surgery, he also wants to measure pressure, PH levels and check to see how well my stomach empties. There is always that possibility that one's LES is pretty good, but if your stomach is not emptying properly or too slowly, it could be the cause of the force that sends things back towards the top.
 
Again thank you............anything else you can think of to tell me is much appreciated.
 
Minnesota Grandma
 

Minnesota Grandma
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Date Joined Mar 2010
Total Posts : 12
   Posted 3/4/2010 10:27 AM (GMT -6)   
In response to the negative posts:
 
I do realize that there are probably more negative posts regarding bad outcomes from Nissan surgery than there are good ones. And I agree, that is probably because the good outcomes seldom have cause to make a post and have no need to complain.
 
I appreciate hearing about the bad outcomes as well as the good ones.
 
Believe me, I do sympathize with those of you who have had bad experiences with your medical care.
 
I am a little gun shy because I have had some pretty poor outcomes with wrong diagnoses in the past, as well as being treated with absolutely no dignity. That is why I have become my own advocate and do not take the advice of one Dr as gospel.
 
It is a shame that it costs so much for our medical care. Otherwise, we could go from Dr to Dr until we found one that had their ducks in a row and truly cared about you.  Pray for smart reform of our health care system. What has taken years to break, cannot be fixed overnight.
 
Thanks again for everyone's thoughts.
 
Minnesota Grandma
 
 

Good Days
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Date Joined Oct 2008
Total Posts : 146
   Posted 3/4/2010 1:13 PM (GMT -6)   
I totally agree with those saying that the surgeon makes the difference.  Mine was a bariatric surgeon who has done load of this surgery.  He had the motility test done and said if it was really bad he could not do the surgery.  I do have some problems but he said it was not enough that would stop the surgery.
 
He also stated that he could offer me a loose (full) wrap and that he was quite good at doing the loose wrap.  Obviously he wasn't just bragging because I too have not had any problems.  I was on clear liquids overnight in the hospital.  After that on full liquids, including oatmeal, blended potato soup, mashed potatoes, baby food etc., for a week.  As Drencha said, until my appointment the next week with the doctor.  I then could eat anything except he did say to wait a couple of months on steak and salad.  Also waiting that long on carbinated drinks.
 
I never felt like things were stuck in my throat while recovering.  But for that 1st week I ate often - every 2-3 hours - and only a 1/2 cup at a time.  I did not experience the shoulder and gas pain that so many do.  The one time I ate over a 1/2 cup I started to get a pain in my shoulder and back.  I went for a walk and it went away.
 
I too would do it again.  I can burp at will.  Never had to throw up yet so don't know.  But please, please make sure your surgeon is the very best in your area.
 
I didn't have a choice of waiting as mine caused sever coughing and I had such a strong cough and the lack of sleep caused my blood pressure to go really high.  No problems since.
 
Good Luck,
Jayne

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 3/4/2010 6:03 PM (GMT -6)   
I too was terrified of the surgery. I had only heard of the bad things. Even my GI gave me horror stories.
I came here and heard all of the stories and it helped me in my decision to go forward an do the surgery.
I searched for a long time for my surgeon. I called their offices and talked with the nurse. If a nurse has a high opinion of the doctor I'd visit him and talk. I had one nurse who trusted her child to have the surgery with the doctor she worked with. She had high praises for him, so this helped me in making my decision.
I'm glad I chose my own surgeon, instead of going with the surgeon my GI wanted.

Joy

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 3/4/2010 8:43 PM (GMT -6)   
Joy-
I have heard many people say their GI gave them horror stories etc. Do you think that could be similar to the reason for less good outcomes reported on the net. They only here mostly from unhappy people who are searching for answers and not the ones who are satisfied?

Take care,
Bill

couchtater
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Date Joined Jul 2009
Total Posts : 14475
   Posted 3/4/2010 9:15 PM (GMT -6)   
Bill, there's an old saying "the squeaky wheel always gets the oil". I believe that has happened with the news on the surgery. Unhappy people will complain the most and the loudest. That's why you hear more bad news than good.
If you look at the 6 o'clock News that is a perfect example.

Joy

Good Days
Regular Member


Date Joined Oct 2008
Total Posts : 146
   Posted 3/5/2010 8:16 AM (GMT -6)   

Joy and Bill,

Yes, I also think that is why we hear so many horrow stories.  That and the fact that so many people blindly follow their GI recommendation. 

I was taking Remicade when I got a fistula (with my chrons) to the bladder and it wouldn't heal.  It just so happened that the Arthritis doctor who administered the Remicade mentioned maybe they could do the bowel resection by lapro.  When I brought this up to the GI doctor he stated that the surgeon he usually used didn't do lapro.  But my gi dr nurse had had by-pass surgery by lapro and my gi asked her about it and we went with that surgeon.  So very glad I did.  The skill of the surgeon makes recoop difference.  I was in the hospital a week because the surgery was so complicated (the bad bowel was in a wad) but I was actually back at work 2 1/2 weeks after surgery.  I really felt great and was not pushing it.  Obviously, this is the same surgeon I chose for the Nissen.

I agree Joy, state of mind makes all the difference in healing and how you feel. 

Jayne

 


steveninomaha
New Member


Date Joined Jan 2010
Total Posts : 11
   Posted 3/6/2010 9:39 PM (GMT -6)   
Hello Minnesota Grandma
 
I hope that you can find a good surgeon to do you surgery for you and I wish you the best. It sounds like surgery is effective for most people, but some don't have positive outcomes. myself I would rather live with the side affects from the surgery than with GERD.
 
I have had GERD for about 13 months. I don't get heartburn at all. My symptons are stomach pain. I feel like someone has punched me in the stomach right above my navel. I also have a heavy, full feeling in my stomach. I asked the doctor why my pain is by my navel when my LES is located much higher. She told me that it is referred pain.
 
Speaking of horror stories about GERD, there is a lot on the net about people who have the awful disease. When I developed GERD last winter, I read stories after stories of people having GERD on the internet that just horrified me. I developed severe anxiety because I realized that all of a sudden my quality of life is gone and that I will never be the same again. In a foolish move after not being able to sleep because of GERD, I quit my job. I couldn't handle the stress the job demanded having GERD. Now I am in Omaha. I got married this past July and moved to where my wife lived. I just found a job that pays half of what I used to make.
 
I am from Minnesota as well, near Alexandria. What area are you from Minnesota Grandma? I miss Minnesota and my wife & I hope to be able to move to MN next year.
 
Good luck! I wish you the best. Hopefully you can find a great surgeon and it is successful.
 
Steve
 
 
 
 

MinnesotaMark
Regular Member


Date Joined Dec 2009
Total Posts : 53
   Posted 3/7/2010 11:34 AM (GMT -6)   
Hi Minnesota Grandma, Steven. Also in Minnesota, Chanhassen which is SW Minneapolis. 39M who has had GERD for 15+ years. Recently had Barrx for BE and am now ready to pull the trigger on a Lap Nissen procedure in the next few months. I also have a H Hernia. I am taking PPIs, lost weight, eat right and am in good shape-have things under control mostly, but I just can't envision taking these drugs forever and also never being able to enjoy the occasional forbidden food.

Thought I would share my research on local surgeons. My top choice is the Minnesota Institute for Minimally Invasive Surgery located in Crosby, MN. Do a web search you will find them. Although all the surgeons there well experienced--but Dr. Howard M. McCollister is argueably one of the best in the state--and probably the best in the mid-west. 1000's of procedures under belt. Good references from patients, nurses, etc. He was one of the first surgeons in MN to do regular LapNissen procedures and continues to teach other surgeons about complex revisional re-dos (fixing surgeon's lap nissen boo-boos). I have also identified some top caliber surgeons with the Mayo in Rochester and with Northwestern Hospital in Minneapolis, but MIMIS is my first choice.

Good Luck
MM

StaceyA
Regular Member


Date Joined Feb 2010
Total Posts : 114
   Posted 3/7/2010 6:04 PM (GMT -6)   
Hi there! I did have the Nissen almost 7 weeks ago. I found the initial diet after surgery difficult. That may be because I was completely unprepared for it. I have not had any need to vomit, but my surgeon told me it shouldn't be a problem. I was able to burp soon after. At this point, I'm able to eat most things. I would not go into this lightly, but if you really need it - it could be a good option.
Best of luck!
Stacey

Minnesota Grandma
New Member


Date Joined Mar 2010
Total Posts : 12
   Posted 3/9/2010 6:39 PM (GMT -6)   
Thank you everyone for your input! Research continues to be high on my list. I am determined to be an informed patient.  I am working at losing some weight and getting more fit.
 
Stacey: you must have had a partial wrap if you are able to burp?
 
Thought I would pass on some info that I have found during my research. Take it or leave it. There are negative effects from the long term use of ant-acids, acid neutralizers, and acid eliminators (the PPI's that are prescribed). The surgeon who is recommending that I have the full wrap Nissan is very against long term use of any of these, especially the PPI's........he insists there is not enough research on the safety of long term use and wonders about the possabilities of cancer.
 
Reduction of stomach acid could allow Salmonella to flourish. Helicobactor (sp) (linked to gastric ulcers and cancers) could also flourish in low acid levels.
 
PPI's have been associated with drastic increases in pneumonia in the elderly.
 
Weakened bones and an increase in the likelyhood of fractures escalates after one year of use of PPI's. PPI's stop or reduce the ability of the body to absorb calcium. I can personally say this is true. I had labs in Dec. 2009 and again in late Feb. 2010. My blood calcium levels have decreased substantially in just those couple of months (in spite of supplements)!!!!!!!
 
PPI's can cause decreased Vitamin absorbtion. They can interfer with the ability of certain drugs to work (many need stomach acid to do their job). They can inerfer with the outcome of some medical tests.
 
Face it, without adequate stomach acid, food can't be digested properly and we probably overburden the rest of the digestive system.
 
Thank you for info on surgical center in Crosby, Mn.  Will investigate it.
 
Minnesota Grandma

couchtater
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Date Joined Jul 2009
Total Posts : 14475
   Posted 3/9/2010 6:51 PM (GMT -6)   
Minnesota Grandma,
My surgeon was experienced in working with obese patients and was comfortable with doing my surgery without me losing weight. I've lost weight since the surgery (20 lbs) and am hoping it continues to go.

Joy

dencha
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Date Joined Feb 2009
Total Posts : 7188
   Posted 3/9/2010 7:41 PM (GMT -6)   
Hi Minnesota Grandma,
I do know that PPI's create lots of problems. Unfortunately over the years, I've depended upon them in order to deal with a very reactive stomach as well as reflux. I did a lot of research before having the Nissen surgery, and was very aware of what to expect post surgery. Actually, I expected the recovery to be much worse judging from what I'd read. I had the surgery laproscopically, which leads to a very speedy recovery time.

I have not had a lot of the "typical" problems post surgery--I have been able to burp (not "at will", but my stomach sort of burps itself), and I haven't had an inordinate amount of bloating and gas. It occurs occasionally, but not all that problematic. I did have a few episodes of stomach "dumping", but again, it was intermittent and not that much of a problem.

That said, I'm having some problems at the moment, and am not so sure that my wrap has held. As I wrote earlier, my steroid usage created a very fragile internal tissue, and the surgeon was concerned that the hernia repair might not hold. I am having some acid issues, and have an appointment to see my GI doc on Friday. Hopefully I can find out if it's a surgical failure or a loose wrap and a very acidic, reactive stomach. Hopefully he'll have some ideas, because I'm really sick of struggling, and I don't want to let it go. So far my lungs are still pretty good. I don't want to get back to where I was pre-surgery. They were very, very unhealthy--dangerously so. The surgery has been a great thing, but I am an unusual case with some complicated issues. Wish me luck!

I am keeping a positive attitude, and will do whatever I need to do to get my GI tract straightened around.
Again, I'm glad you've joined us! We can all learn from each other, and offer support through our challenges.
Take care,
Denise

Minnesota Grandma
New Member


Date Joined Mar 2010
Total Posts : 12
   Posted 3/9/2010 9:10 PM (GMT -6)   
yeah Denise:
 
Definately keep the good attitude. That will take you a long way. It is a frustrating process......I can testify to that. Gerd is only one of my multiple problems. I am one of those "unfortunate" souls who has all of those things that are "not textbook" and finding doctors who will take time and "think outside of the box" has been a real exhausting ordeal.  I feel like sending roses and a big thank you to the handful of Dr's who have gone the extra mile for me...............My prayers and best wishes to all.!!!!!!!!!!!
 
I just met a gal who had the full wrap at about age 27. 18 months later, she had kidney stones and severe vomiting. It is now 10 years later and she is sure her illness after the surgery "undid" some of her wrap. She has been searching for someone to re-do her wrap, but is having uerology (sp) problems and has to be cleared in this area before her surgeon will "touch" her.
 
My gut says the surgeon is giving her the brush off. I am going to look into the surgical center that one of the posts suggested in Crosby, MN. Peaked earlier and it looks like the surgeons are well qualified. I will definately post comments if I talk to them. I have to find out if they are in my insurance's network..............
 
Minnesota Grandma
 
 

Alcie
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Date Joined Oct 2009
Total Posts : 5029
   Posted 3/9/2010 9:56 PM (GMT -6)   
Minnesota -
Go find a different surgeon STAT!
Mesh went out a long time ago (in terms of this surgery). It tends to erode into the esophagus! My surgeon, internationally reknowned, uses tissue from the patient for reinforcement. He's done 20k of these!

Also there is no way he can say you need a FULL wrap without the results of swallow testing. As you age your ability to swallow decreases. You aren't old for a grandma. I've got 7 years on you. I had a Toupet fundoplication - basically the same as the full Nissen, but a partial wrap. It was done because I don't swallow strongly enough to pass food through a full wrap.

This modification of the surgery also lets me burp - although I couldn't for the first 3+ months. I don't know if I can vomit, and I'm not taking any chances. I carry Zofran with me just in case.

Fundoplication must be fitted to the patient, not the other way around.
Alcie
 
 


Minnesota Grandma
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Date Joined Mar 2010
Total Posts : 12
   Posted 3/10/2010 1:26 PM (GMT -6)   
I must say that I agree with your last statement.....the fundoplication must fit the patient, not the other way around.....one of the reasons I put on the brakes and am doing research. Interesting to hear about the mesh. My surgeon said he uses it in addition to stitches. Makes sense when you think about the mesh, where it would be located in proximatey to the esophagus and the possibility of complications.   Thank you.
 
Minnesota Grandma
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