Does Hiatal Hernia surgery require Fundoplication ?

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gerd_hater
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Date Joined Oct 2012
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   Posted 11/22/2012 10:42 AM (GMT -6)   
Anyone knows why Hiatal Hernia correction is accompanied by fundoplication in the presence of GERD symptoms ?

Isn't it worth a try to see if sphincter function gets restored just by hernia correction ?

sammywalker21
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Date Joined Nov 2012
Total Posts : 105
   Posted 11/22/2012 4:29 PM (GMT -6)   
It's to my understanding they push the hiatus hernia back into place and to stop it piping back through the diaphragm it needs to be tightened hence the fundoplication don't think it nessercarily has to be a Nissan maybe a partial one will do it this is how my doc explained it to me

Virgogirl67
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Date Joined Feb 2010
Total Posts : 130
   Posted 11/23/2012 2:35 AM (GMT -6)   
I asked my surgeon that very question. She said it is not just the hernia that causes GERD, it simply irritates the situation and is corrected during the fundo process. She told me the (all call it valve) at the end of the esophagus is faulty regardless - it is the hernia that creates the weakness.

I think it's one of those chicken before the egg mysteries of life. I just had to trust. I am glad I had the surgery almost a year ago. I still have stomach burning due to gastritis, but no reflux; some break through only if I over eat and create too much pressure.

gerd_hater
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Date Joined Oct 2012
Total Posts : 322
   Posted 11/23/2012 3:41 AM (GMT -6)   
Hi Virgogirl67,

Going through your previous posts, it seems like you had a Nissen. Where did you have it done ? At the moment, I am thinking of LINX because I am scared of Nissen (for one reason or the other). It seems like you are one of the happy wrap clubbers ! Would be interested in knowing if you have any side effects whatsoever. Thanks!

Subra

Virgogirl67
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Date Joined Feb 2010
Total Posts : 130
   Posted 11/23/2012 11:59 PM (GMT -6)   
Hi Subra,

I do wish I would have researched other options a bit more, like the endo sinch etc. I would say maybe it is best to start with the least invasive procedure initially. I have Barrett's Esophagus and it seemed to be the suggested procedure from my doctors. I also spoked with 3 people that had the procedure and swore it was the best decision they made. i thought at least 1 of them would say something negative, but they were all very positive about the procedure.

I had mine done at University of Cincinnati Medical Center by doctor Jocyln Collins. At first it was difficult, but over this year it has gotten much better. I am off Nexium and only on prescription pepcid.

The side effects at first was an inability on days 4 through 9 to keep any food down, and that was because the wrap swelled. Inability to burp keeps a lot of air in your system, so it equates to an increase in gas unfortunately. I still find some normal reflux foods not tolerable; tomato based products, alcohol, orange juice. And really carbonated drinks are a big no-no, as is using a straw to drink - just introduces too much air in your system.

I am a bit worried as of late. I seem to be having a bit of reflux and have been able to burp up some air over the past week. Which is wonderful, but makes me wonder if things loosened up a bit. I was just put on a med that I think may be causing this. As much as I hate upper GI's, I am having one Wednesday so my local GI doc can make sure things look ok, and biopsy my Barretts.

If your surgeon is ok starting with the least invasive method, and then moving forward with the Nissen, then that is what I would do. As long as the surgeon feels a Nissen can be done in addition to the alternative procedure if need be at a later time. It's such a frustrating disorder. All in all, I am glad I had the Nissen Fundo, but I do wish I would have started with something less intense. I was in the hospital for 3 days. Returned to work in 5 weeks. Best of luck to you, please keep us all posted on what you decide and how you are doing. I think it just helps everyone.

gerd_hater
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Date Joined Oct 2012
Total Posts : 322
   Posted 11/24/2012 12:42 AM (GMT -6)   
Hi Virgogirl67,

Happy to hear that you are glad about your Nissen, but also concerned about the pain you must have sometimes with the gas bloat. If your symptoms become bad, I believe there will be a way to unwrap (according to some other post elsewhere, the only thing I've heard that makes it difficult is to find a surgeon who does it, which probably means that the undo is riskier and you will have to make a compelling case)

I am having some swallowing problems at the throat which usually does translate to insufficient esophageal motility to qualify me for LINX. Going off of PPIs the last 6 months wrecked havoc with my esophagus which needs to heal again. I will keep everyone posted on how things go with LINX. Just initiated dialogue with Dr.Lipham at USC.

My hope is that LINX will work to some degree as most patients think it did help their reflux significantly. Eventually in a few years time, I can get it explanted and move on to the next generation treatments. I see GERD as a continuous maintenance treatment for the next 15 to 20 years at which point I'd speculate there will be rocksolid lifelong solutions. The reason for my hope is that there is a significant commercial opportunity in GERD surgeries because they are severely on the rise with today's fastfood and alcohol lifestyles.

Virgogirl67
Regular Member


Date Joined Feb 2010
Total Posts : 130
   Posted 11/24/2012 10:22 AM (GMT -6)   
Subra, I so agree with you, and think you are approaching the situation as I wish I had. I should have pushed for a less invasive surgery, but with Barrett's Esophagus sounding so scary and the surgeon feeling confident Nissen was the best solution, I just had to go on trust.

I agree, I think this disorder is very prevalent and becoming more so. I am so surprised that there are not more skilled surgeons and researchers that are looking for advanced treatments. It's hard enough to find the best surgeon for the current treatments! Although, there could be research and more physicians realizing treating this disease will keep them in demand for years to come, I probably just don't realize it.

Makes me a bit sad that I had to go so drastic when I know over the next decade or so there will be even better solutions. That's how life goes I suppose.

For me, I just need to continue my quest to make the most of a decision that I feel is done. The reversal scares me, so unless there are unbearable complication down the road. I will just need to continue to tweak my life style to find the best way to live with the Nissen side effects. I do worry about Barrett's. My insurance would no longer pay for Nexium a few years ago. I was on it for 8 years and had clean upper GI's. My doctor fought hard to get me back on it, but the insurance would not budge. I paid for it myself for a while, but just too expensive. The reflux was getting worse, and then the result was Barrett's. I firmly believe this did not have to happen. Our medical system still treats disease instead of focusing on prevention. Ironically a month after my surgery, insurance decided to cover Nexium again. Figures :-). Take care, and yes, please keep posting. Anita (Virgogirl)

GC1pink
Veteran Member


Date Joined Nov 2012
Total Posts : 532
   Posted 11/24/2012 5:02 PM (GMT -6)   
Hi,

I'm doing research on my own as I also have a hiatus hernia - I found this - I don't know if it's in use yet, but it does look interesting.

http://www.faqs.org/patents/app/20120071904

buzzmoz
Regular Member


Date Joined Mar 2012
Total Posts : 52
   Posted 11/24/2012 8:26 PM (GMT -6)   
Hi there'
I was curious as to whether that was the case myself and so I asked the surgeon I had, and he suggested that perhaps a fundoplication may not have to go hand in hand with a HH repair and said it was something that was just done routinely as nobody had bothered to do a study on that, and so data was unavailable. Incredible really when you think about it, as a fundoplication is such a major thing to have done, be it a full of partial wrap. It alters your digestive system completey and can take a couple of years before you feel like you are digesting things correctly again. Although quite successful, some are indeed failures and wind up causing more or different problems than you experienced pre op. I think the thing that has proven to be the most challenging when it comes to repairing the hiatus is to somehow stop the stomach's desire to go back to where it has been living comfortably , for God knows how long. Perhaps the wrap assists with keeping the stomach below the diaphragm. Maybe newly herniated stomachs haven't become accustomed to living above and below your diaphragm alternately, and therefore can be treated with more success if surgery is done soon after herniation occurs. I guess then the other thing to look at is that alot of people have hernias that remain asymptomatic or can be treated successfully with life style changes and PPI's.

dencha
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Date Joined Feb 2009
Total Posts : 7181
   Posted 11/24/2012 9:28 PM (GMT -6)   
Hi gerd_hater,
I found this research paper on the subject:
 
The conlusion seemed to be that the hernia repair with fundoplication yields better results.
 
Here's another very interesting resource regarding GERD surgery. 
 
Good luck in your search for answers!
Denise
GERD/Heartburn Moderator
Nissen Fundoplication 2/09
Allergy/Asthma

"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.”
Eckhart Tolle

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 11/25/2012 1:53 AM (GMT -6)   
He Denise,

The first link only talks about LARGE HH (type II to IV, www.drugs.com/cg/hiatal-hernia.html), which excludes sliding hernias (80% of cases are sliding).

Subra

GC1pink
Veteran Member


Date Joined Nov 2012
Total Posts : 532
   Posted 11/25/2012 6:28 AM (GMT -6)   
Hi,

I don't know why they just can't do the Tif procedure for a small Hiatus Hernia, without having to create a new valve? If they suction the hiatus hernia and staple it into the Z line, would that not work? Then if you still had reflux, surely you could undo that procedure and have the full Tif?

Just a thought.

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 11/25/2012 1:20 PM (GMT -6)   
Hi Anita,

Sorry to hear about your insurance troubles and the fresh onset of reflux. I hope the reflux is just a passing occasional thing. Perhaps the other members of the wrapped club might tell you if it is something to worry about.

From your post, it otherwise seems like you are fairly satisfied with the NF, except for gas bloat ? I hope you don't have any thing else major to handle with the NF. The thought of newer solutions will always exist, but on the flip side, you do have a chance to unwrap if a truly great solution is available and you are protecting yourself from further damages for the moment.

I really hope things continue to improve for you

Subra

33mastomichael
New Member


Date Joined Nov 2012
Total Posts : 14
   Posted 11/25/2012 3:19 PM (GMT -6)   
i had reflux for twenty years then i was one of the lucky ones to find some one that explain to me way it happens.I was due to have a op when some one said go and see this massage specailist ,she explain to me how fascia can affect our insides.She massage my abdomen and after 4 treameants i came of the pills .

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 11/25/2012 3:28 PM (GMT -6)   
Hi 33mastomichael, care to share her contact info ? Also how long since you came off pills ?

Virgogirl67
Regular Member


Date Joined Feb 2010
Total Posts : 130
   Posted 11/26/2012 3:30 PM (GMT -6)   
Thanks for the support Subra. I did have to cancel the follow up upper GI to check the status of the wrap. I have had a very bad chest cold and they said they do not like to do the procedure during an active chest cold - intense coughing. Pushed it off to January.

They did say it is very difficult to unwrap the fundo because they create extra scar tissue on purpose so it does not slip. They also said that it does help the hernia from returning. However, a different surgeon on call one night said there is a slight risk that the entire wrap and stomach may become herniated - only a slight chance - but that was scary to hear. He said if I suspect that, to get to emergency room. Yikes!!! They have to warn you of all possibilities I suppose.

Mastomichael, that is great!! Hope you continue to have success with the massage! When you said she massaged your adomen, it reminded me that I did go to the Ohio Wellness Center years ago, shortly after I acquired reflux, and a naturalist there taught me how to massage my abdomen. I tried it for a while, but did not have luck. Of course when specialist does it, that is probably best.
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