Who is the best Nissen Surgeon?

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M8
Regular Member


Date Joined Feb 2012
Total Posts : 24
   Posted 9/29/2012 10:10 AM (GMT -6)   
As some of you'll know I've been dealing with GERD for the past 9 - 10 years now and within the past year has gotten out of control.

For those that don't know my story you can find it in these previous threads:

http://www.healingwell.com/community/default.aspx?f=45&m=2352707

http://www.healingwell.com/community/default.aspx?f=45&m=2473055&g=2474558#m2474558

I'm leaning towards finally working up the confidence to have the surgery done and am looking for the best surgeon that I can find. I live in the New Orleans area but have no problem traveling somewhere to have it done. I feel that the quality of the surgeon plays a huge part in the success of this surgery.

I found a surgeon in Baton Rouge that comes highly recommended as a laparoscopic surgeon but haven't meet any of his patients that had the Nissen done. I meet with him and he said that he has performed about 400 of them in his career over the past 10 years or so.

My Gastro doesn't have any surgeon that he specifically recommends but did comment that he wouldn't have a problem having the surgeon I meet with have it done.

Any ideas, comments, suggestions?

My BIGGEST concern is since I'm only 28 and my home and work life requires heavy lifting I just don't want it to come undone and have to have multiple redoes.

Has anyone heard of these things lasting for a long time in a person that doesn't work behind a desk and performers strenuous activity?

As always thank you everyone for your help and assistance.

sillylilly
Regular Member


Date Joined Oct 2006
Total Posts : 317
   Posted 9/29/2012 10:53 AM (GMT -6)   
Hi M8,

Sorry to hear you are suffering with GERD so young in your life. I had a Hill repair done 4 years
ago (age 66) and am doing great. I actually flew to Seattle, Wa. from Florida where I live to have
it done by the best surgeon who does the Hill repair. It is done mostly in the northwest because
that is where Dr. Hill invented the surgery.

Both the Hill and Nissen do the job, but I have to be honest with you that lifting heavy equipment or boxes is not recommended for either surgery. The Nissen wrap can slip and I know someone who
lifted some heavy boxes after 3 years with the Nissen and she had to have a redo. The surtures in
the Hill repair can loosen with heavy pressure from lifting, body building, etc., causing the repair
to loosen.

Lifestyle changes would have to be considered for you to feel comfortable going through with
the Nissen surgery. I would be concerned if any doctor tells you that he can do this surgery
and you can lift any amount of weight afterward.

I wish I could be more encouraging about it but it's something to consider before going ahead.
God bless,
Carolyn

M8
Regular Member


Date Joined Feb 2012
Total Posts : 24
   Posted 9/29/2012 12:46 PM (GMT -6)   
Lilly,

I've been researching GERD Surgeries for the past year and this is the first I've ever heard of the "Hill". Can you lead me to some good information on it?

In my instance would it be a better surgery for me over the Nissen?

Thank you

hitThePost
Regular Member


Date Joined Dec 2011
Total Posts : 133
   Posted 9/29/2012 2:30 PM (GMT -6)   
Dr Luketich from UPMC and his staff have done over 4,000 Nissens. Also, Dr Robert Sewell from TX is another well-known Nissen surgeon....

sillylilly
Regular Member


Date Joined Oct 2006
Total Posts : 317
   Posted 9/29/2012 5:48 PM (GMT -6)   
Hi M8,

The Hill Repair is a more complicated surgical technique and more difficult to teach, therefore,
it is not done as much as the Nissen. Dr. Aye at Swedish Hospital in Seattle did my surgery.
Dr. Aye is the protege of Dr. Hill who invented the surgery. The Hill repair actually creates a
new LES junction, instead of the wrap, which is more anatomically correct creating less side effects
than the Nissen, less bloating and gas.

Google laparoscopic Hill repair and you should find plenty of
information about it. They also now have a Hill/Nissen hybrid repair that incorporates the best
of each surgery...sounds interesting to me.

I had a phone consultation with Dr. Aye (he doesn't charge a fee) initially for 45 minutes discussing
my options with him. He is absolutely the nicest and gentlest man who truly cares about his
patients. I was so blessed to find him. And a brilliant surgeon. He will ask you to have a 24-hour Bravo, a manometry test and I think a barium swallow test sent to him to review before he sets up the appointment for surgery.
I flew out there, he did an endoscopy just to see for himself and the surgery was the next morning.
I was out of the hospital the next day, stayed another 3 days for observation and flew home. Had 2 or 3 phone consultations after that and everything has been good.

I know what misery you are going through so I hope your research pays off soon.
carolyn

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 9/29/2012 6:05 PM (GMT -6)   
Go see Dr. V. Bagnato in Albany, GA
He invented the modified Hill. He was also the first doctor to do the nissen laproscopic surgery in Georgia. He was my doctor.
Joy
Lupus, Fibromyalgia, Glaucoma, Asthma, Hypothyriodism, Sleep Apnea, Degenerative Disk and Facet Disease, and Allergies

When life throws you lemons....
Pick them up and throw them right back at them! :))

M8
Regular Member


Date Joined Feb 2012
Total Posts : 24
   Posted 9/29/2012 6:43 PM (GMT -6)   
All I know is I'm so tired of being in pain. I have acid reflux 24/7 and I'm currently on 40 mg of Nexium 2 x day, plus Carafate. I've had a 48 Bravo PH, Motility, and multiple Endoscopes done. Went to three different Gastros. Flew all the way to Tampa to visit the # 1 esophagus guy in the world. All say I'm at the end of my options.

I'm just afraid that being young I'll be going through multiple redos and with each redo the success rate falls.

I enjoy being active at home and at work. My job is onboard a ship at sea so there is a lot of movement/activity. Heck just the other day we went through a rough storm that had recorded 45' seas. Fortunately at work I'm in a position where I don't have to pick up/drag heavy things around. Usually when I do its my own choice instead of just telling someone to give me a hand.

At home thats a different story. I enjoy running my tractor, cutting trees down, and working on my boat. This past time home we had to deal with the Hurricane and of course the clean up that comes with it. I tore my back up about 5 months ago and had the hardest time forcing myself not to lift too much.

The Gastro in Tampa said if you want it to last you shouldn't lift more then 25 lbs for the rest of your life. I can respect that due to the length of time I need it to last that its reasonable. Of course what is reasonable is different then what truly happens. I don't know if he was trying to scare me or doesn't understand my life but I don't pick up and pull 100 lb things all day every day. I don't really pick up more then 20 lbs on an average day but do at times pick up some heavy items. I don't have any desire to body build or weight lift I just want to go to work do my job and go home and enjoy an active life.

I'm really interested to hear about a different option to the Nissen. The Nissen has a good track record and maybe what I end up with. I just want to go with what would be best for me. I hope to find someone that has the experience and isn't biased to lead me in the correct direction.

Thank you for everyone's time and assistance.

opnwhl4
Forum Moderator


Date Joined Dec 2008
Total Posts : 4961
   Posted 9/29/2012 7:53 PM (GMT -6)   
The Cleveland Clinic is a very good place to go if you can travel. Loyola Medical Center outside Chicago has a great nissen surgeon there. He specializes in swallowing problems and nissen redoes. He did my first redo and it was perfect until the repair for an esophageal perforation ruined it about 2 years later. His name is Dr Marco Fisichella, he has several papers on the internet.

take care,
Bill
opnwhl4
Moderator: GERD/Heartburn
Nissen 6/06 and 5/09
#3 on 8/24/11

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 9/29/2012 9:22 PM (GMT -6)   
Hi M8,
In my opinion you don't have to have the BEST (whatever that means), but you need a surgeon who is skilled and highly experienced in doing Nissen procedures.  You can have the best surgeon ever, and he/she might not have sufficient experience doing Nissens. 
 
Whatever surgeon you have should do sufficient testing (endoscopy, 24hr PH monitor, manometry, barium swallow, and perhaps a stomach emptying test.)  If he/she doesn't order these tests, it makes his/her expertise suspect.  An excellent Nissen surgeon wants to know who will be a good candidate for the procedure and these tests will help in this evaluation.
 
The rule of thumb is AT LEAST 300-400 surgeries under his/her belt in a smaller city and over 1000 in a large city.  Interview more than one surgery if you can.  If you have a great GI doc that you trust, go with his/her recommendation.
 
As far as the lifting issue goes, I can't help you.  In my opinion it would be an issue to bring up with your surgeon.  It's definitely a consideration, because certainly lifting is an issue.
 
Good luck with your decision!
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.”

She 1
Regular Member


Date Joined Jul 2012
Total Posts : 32
   Posted 10/4/2012 5:28 PM (GMT -6)   
Go see V John Bagnato in Macon Ga..garefluxsurgery.com
He does the hill repair & he's done thousands..check out his website..good luck!

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 10/4/2012 8:26 PM (GMT -6)   
He's moved to Macon? Last I heard he was in Albany.
He was my surgeon. :)
Joy
Lupus, Fibromyalgia, Glaucoma, Asthma, Hypothyriodism, Sleep Apnea, Degenerative Disk and Facet Disease, and Allergies

When life throws you lemons....
Pick them up and throw them right back at them! :))

She 1
Regular Member


Date Joined Jul 2012
Total Posts : 32
   Posted 10/4/2012 8:45 PM (GMT -6)   
Yes ma'am he did my surgery at Colliseum Hospital in Macon in June..No longer in Albany.I didn't have as far to drive as you did :)

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 10/4/2012 11:24 PM (GMT -6)   
Good thing he moved further North. If I ever need a re-do he's first on my list.
Joy
Lupus, Fibromyalgia, Glaucoma, Asthma, Hypothyriodism, Sleep Apnea, Degenerative Disk and Facet Disease, and Allergies

When life throws you lemons....
Pick them up and throw them right back at them! :))

speedygerd
Regular Member


Date Joined Jan 2012
Total Posts : 87
   Posted 10/5/2012 1:29 PM (GMT -6)   
M8,

Have you considered the Torax Linx device? Although it's fairly new, it doesn't have the lifting restrictions that come along with the Nissen and it should theoretically last forever (or a long time, since it doesn't depend on sutures that can loosen).

I am in a similar situation to you - fairly young (33) with severe GERD, and I don't want to spend the rest of my life worrying about doing every day things will bring my gerd storming back after a failed nissen. I am seriously considering pursuing the linx as the answer to my problems, as it doesn't have many of the drawbacks of the nissen, despite it's limited track record.

M8
Regular Member


Date Joined Feb 2012
Total Posts : 24
   Posted 10/5/2012 2:48 PM (GMT -6)   
speedygerd said...
M8,

Have you considered the Torax Linx device? Although it's fairly new, it doesn't have the lifting restrictions that come along with the Nissen and it should theoretically last forever (or a long time, since it doesn't depend on sutures that can loosen).

I am in a similar situation to you - fairly young (33) with severe GERD, and I don't want to spend the rest of my life worrying about doing every day things will bring my gerd storming back after a failed nissen. I am seriously considering pursuing the linx as the answer to my problems, as it doesn't have many of the drawbacks of the nissen, despite it's limited track record.


I've considered it but the true track record appears well below the Company's claims. Look at the members on this forum from my rough calculation its below 50%. Plus I have a concern of it causing esophagus erosion.

It appears that it may end up being added to the list of failures like the TIF. Yes some people may have success with it but it doesn't compare to the track record of the Nissen.

I'm looking into the Hill or a Nissen/Hill Hybrid.

I like you am afraid of tearing it apart and having to go through a redo. Is the Nissen the perfect solution for someone like ourselves? I believe that the answer is no but the choices that we have to choose from are slim to none.

I wish there was a good answer but in my eyes there aren't any. For the past year I've been fighting it but am now tired of being in pain everyday. This affects every second of my day.

speedygerd
Regular Member


Date Joined Jan 2012
Total Posts : 87
   Posted 10/5/2012 3:21 PM (GMT -6)   
I agree that there's no good answer, and they all have their drawbacks.

However, I think your linx analysis suffers from some selection bias, as people who are "cured" don't stick around and post on GERD forums all day. Only the people that continue to suffer and are looking for answers continue to post, which makes the outlook more bleak than it seems.

Also, based on the number of complaints about failed Nissen's and other complications, you could draw the same conclusions from this board that the Nissen is not a reliable operation, when in fact it is quite time tested and reliable when performed by a skilled surgeon (90-95% success rate?).

Here's one independent study that seems to indicate a very high success rate for the Linx device four years out, with minimal complications:

http://www.ncbi.nlm.nih.gov/pubmed?term=Surgical%20Endoscopy%3A%20The%20LINX%C2%AE%20reflux%20management%20system%3A%20confirmed%20safety%20and%20efficacy%20now%20at%204%20years

In my mind, I almost consider the Linx device to be a bridge to a true cure for GERD, which will hopefully arise within our lifetimes (stems cells, muscle cell implantation, etc.) and the fact that it is reversible is also very appealing to me.

M8
Regular Member


Date Joined Feb 2012
Total Posts : 24
   Posted 10/6/2012 6:58 PM (GMT -6)   
dencha said...
Hi M8,
In my opinion you don't have to have the BEST (whatever that means), but you need a surgeon who is skilled and highly experienced in doing Nissen procedures. You can have the best surgeon ever, and he/she might not have sufficient experience doing Nissens.

Whatever surgeon you have should do sufficient testing (endoscopy, 24hr PH monitor, manometry, barium swallow, and perhaps a stomach emptying test.) If he/she doesn't order these tests, it makes his/her expertise suspect. An excellent Nissen surgeon wants to know who will be a good candidate for the procedure and these tests will help in this evaluation.

The rule of thumb is AT LEAST 300-400 surgeries under his/her belt in a smaller city and over 1000 in a large city. Interview more than one surgery if you can. If you have a great GI doc that you trust, go with his/her recommendation.

As far as the lifting issue goes, I can't help you. In my opinion it would be an issue to bring up with your surgeon. It's definitely a consideration, because certainly lifting is an issue.

Good luck with your decision!
Denise


I currently live between New Orleans and Baton Rouge which are considered mid sized cities and the surgeon that was recommend to me by my Gastro has completed over 400 Nissens in his career.

I've been through 48hr Bravo Ph, manometry, and I do remember having a MRI or something after drinking a lot of chalky liquid.

I appreciate everyone's suggestions and am interested with speaking with Dr. Bagnato, Dr. Wright, & Dr. Aye

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 10/7/2012 9:05 AM (GMT -6)   
Hi M8,
Good luck wth your search.  The chalky liquid test was likely the barium swallow test.  It watches the behavior of the liquid as it goes down the esophagus into the stomach.  It can generally spot hiatus hernias, as well as severe reflux.  It's the least invasive of all the tests and is generally the one that doctors order first.
 
I hope you find a great surgeon to do your work.  The surgeon your GI doc recommended sounds well-qualified.  Mine had done 300-400 during the past 10 years or so when laproscopic surgery became the standard Nissen procedure.  I've read that it was helpful when the surgery began to be done laproscopically, because it limited the number of surgeons doing the procedure.  When the procedures are done by fewer surgeons, they become much more experienced.  In the city where I live now (a medium-sized city) there is a surgeon who (as I was told by my ENT and PCP), "does all the Nissens". 
 
When I selected my surgeon (in a smaller city than where I am now), I took the advice of my GI doc and asked a nurse anesthetist who worked at the same hospital.  Both indicated that he is the surgeon they would go to if they had the need.  That was enough for me.  I interviewed him with a list of questions, and within 3 weeks had the surgery.
 
I had considered going out of town to a center, in order to take advantage of the most skilled and experienced surgeon.  I discussed this option with my PCP of 25 years.  He supported whatever I decided to do, but did point out that if I went far away (it would have been hundreds of miles), I would have to go back there if I had a problem, as nobody local would touch me.  After weighing all the alternatives, as well as the pros and cons, I made the decision that was right for me.  I have been very happy with the results.
 
If I were to need a redo, I would once again consider all the alternatives, and might end up at a center, as redos are more difficult and done less often.  I'll face that decision when I come to it.
 
This is a decision only you can make.  What one person decides might not be the right for another.  I wish you luck in your search.  The work you're doing to research surgeons and all your options is a good thing.  Continue educating yourself, asking questions, and exploring options.  It's no rush.  You've lived with the affects of GERD this long, you can wait a little longer!
 
Best wishes,
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) : 10/7/2012 9:08:24 AM (GMT-6)


ksound
New Member


Date Joined Apr 2014
Total Posts : 2
   Posted 4/3/2014 11:33 AM (GMT -6)   
M8, did you have the surgery done in Baton Rouge?  Who was the surgeon recommended?  Thanks.
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