Reflux after Nissen

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Obsidian99
New Member


Date Joined Mar 2012
Total Posts : 18
   Posted 4/13/2012 3:16 PM (GMT -6)   
I'm now at the 6-week mark post-Nissen, and I'm trying to believe that the surgery will turn out successful, but I'm having serious doubts.

Even just a few days after surgery, I began to experience symptoms that I had previously associated with reflux. I attributed those symptoms, such as being able to taste food in the back of my throat long after I had eaten it, to food failing to get past the wrap site completely, and thus mimicking reflux by staying in my esophagus and then coming up later. I'm starting to believe that I was just fooling myself.

5 days post-surgery, I began to be able to burp. A few days later, I was burping freely.

about 2 weeks post-surgery, I was not really getting reflux symptoms, and food was not going down easily (as I switched off of liquids), so I felt that was a good sign.

about 3 weeks post-surgery, I had my first true reflux symptom that clearly contained acid. I freaked out a bit, and posted here, but I got calmed down. I had just travelled to a conference that I had to speak at, and had a diet change, so I attributed that episode to pressure changes and diet. Sure enough, a few days later - and after returning to liquid diet - the reflux symptoms had gone back to what I was saying earlier - something that I could tell myself was not true reflux, just a mimic.

But now I'm 6 weeks out. I can eat just about anything without it getting stuck at the wrap site. I've had an episode of "volume reflux" that lasted for an hour or so one evening; and I'm experiencing symptoms very often throughout the day that really feel like minor reflux. It's become a constant distraction and source of distress for me. I can hardly focus on anything else. I have an appointment with my GI in 2 weeks, and a third follow up with my surgeon in 3 weeks.

In the meantime, I'm wondering about these things:

1- Can any of this be considered normal healing? Maybe I'm doing something wrong, or maybe it will get better. It seems like the symptoms have gotten progressively worse, but can that reverse?

2- Is there a way to assess whether my wrap is intact? Would I know if it had come undone? I haven't been having the nightly, massive volume reflux from before, so that gives me some hope.

3- Does anyone know if, in the event that I need to be repaired (either because the wrap has come undone, or if it wasn't tight enough to begin with), can that be done laparoscopically? Or is that always an open-surgery?

4- How long would one normally want to wait before considering another surgery?

I just want my reflux to be gone and get on with healing. I was prepared for a hard few months, but I was expecting it to be hard because I would be eating differently, and chewing differently, and there would be pain; I was not at all prepared for still having reflux issues while I went through all of the healing. I would be okay with that if I felt that the reflux would go away with time, but I'm really worried that it's just going to continue to worsen until I'm back to square one.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 4/14/2012 10:13 AM (GMT -6)   
Hi Obsidian,
I'm sorry to hear you're having so many problems.  I'm not sure I can help, but will give it a try.  I suggest that if you haven't already, you call your surgeon's office and arrange a face-to-face meeting with him/her/or medical staff.
 
In the meantime, here's my take:

1- Can any of this be considered normal healing? Maybe I'm doing something wrong, or maybe it will get better. It seems like the symptoms have gotten progressively worse, but can that reverse?
True high volume reflux symtoms are not normal.  Still there can be symptoms that do a great job of mimicking reflux because, as I'm sure you've read here many times, "the esophagus is a dumb organ" and it interprets all pain as reflux.
 
I do believe that a loose wrap can work just fine, and continue to hold food and acid in the stomach well, while allowing you to burp.  I actually discussed this with my surgeon because I had the same worries as you.
 
It is possible that acid can reflux during the early weeks. That said, high volume refluxing isn't typical.  Food at the wrap site can ferment if it is there a long time, and certainly can mimic real reflux. 
 
If you've pushed too much with your eating it's possible to back off and begin eating the way you did at an earlier stage.  If you do this for an extended period of time you should see some improvement if that's the cause.  It won't be immediate, though.  Patience.

2- Is there a way to assess whether my wrap is intact? Would I know if it had come undone? I haven't been having the nightly, massive volume reflux from before, so that gives me some hope.
That is a very good indication that it's not a failed wrap.  I believe I mentioned to you before that it's possible to get reflux after Nissen surgery, but it will be much, much less frequent and less intense.  The surgeon can't create zero reflux without making it impossible to swallow.  Burping is another benefit that can come from a wrap that is not too tight.  Bloating can be debilitating with a too-tight wrap. 
 
I would guess that if you tell your surgeon that you're no longer getting high volume relux while sleeping he/she will feel very confident that your wrap is a huge success.

3- Does anyone know if, in the event that I need to be repaired (either because the wrap has come undone, or if it wasn't tight enough to begin with), can that be done laparoscopically? Or is that always an open-surgery?

I asked my GI doctor this very same question.  During my recovery I had a lung infection/asthma issue that was causing me to cough forcefully and constantly.  I was very worried that I would ruin my wrap and would need a redo.

My GI doc said that a redo could indeed be done laproscopically, which was a big comfort to me.  I had heard other places that it would need to be done as an open procedure.

On the topic of open procedures, our moderator, Bill, has had an open redo and he said that he was very surprised that the recovery was about as easy as the laproscopic surgery recovery.


4- How long would one normally want to wait before considering another surgery? 

My guess is pretty close to the year mark, as at that point you'd have healed "completely".  Still, if someone were in severe stress, I'm sure that it could be done sooner.  However, a good surgeon will be very hesitant to perform a redo before you've healed completely, because it's not something that should be done unless it is absolutely necessary.  Each redo surgery is more difficult than the last, so you want to avoid a possibly unnecessary one.

I don't know if I've helped at all, but that's my take on your situation and questions.  I'm sure others will be by to weigh it.

Hang in there!

Denise


Words of wisdom by Eckhart Tolle:
"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”

Post Edited (dencha) : 4/14/2012 9:18:28 AM (GMT-6)


joe1619
Regular Member


Date Joined Dec 2009
Total Posts : 293
   Posted 4/17/2012 5:49 PM (GMT -6)   
dencha is right. i wanted a redo immediately after my wrap too as symptoms persisted and a barium showed reflux. then things slowly got better i then was told(i shouldnt have listened) no restrictions. chocolate, pizza, margaritas..nothing in excess but i gained 20lbs back and started running. i mean running fast. then i started eating later due to work and what months earlier caused me problems now. My throat hurts so bad i am begging for a redo, but the wrap is intact. i see a bariatric surgeon on thursday but i know shes gonna say its tight enough. recently got sick and could not vomit just wretching. be patient you may get better yet
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