Request for Future Fundiplication Advice

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Retired Seabee
Regular Member


Date Joined Feb 2013
Total Posts : 129
   Posted 2/26/2013 9:41 PM (GMT -6)   
I am the latest newbie and am seeking advice.  I am a  73 year old in good physical condition and play tennis 6 days a week and walk 3-5 miles in a mall when tennis is impossible.  I have a moderate-sized hiatal hernia and relatively weak swallowing for related reasons.  I have had the problem for 30+ years and, with lots of antacids, I have coped with it.  Within the last five years the problem with reflux has increased and two years ago I had a difficulty swallowing. The Gastroenterologist dilated a stricture which relieved the swallowing problem and he also prescribed Nexium which relieved the acid problem but not the reflux itself.  Last year I had a serious lung abscess which was attributed to the nighttime reflux spilling over into my respiratory tract.  It took months of powerful antibiotics to heal.  I suspect that much of the food that refluxes is being retained for some reason in the upper part of the stomach which is above the diaphragm and only gets into the lower part by gravity flow.  Therefore it is "poised" in the part of the esophagus waiting for a burp to release it into my mouth.
 
I don't really have the debilitating acid reflux that most of the discussions on the internet report.  I don't have the breathing difficulties, hoarseness, coughing, etc. that most people have but I do frequently have to clear my throat and burp.  Over the years, I have done all of the usual precautions--elevated bed, wedge pillow, moderate sized meals, etc.  I know that I am still digesting enough food to maintain my weight and I have good energy.  I know that I can survive and live out my remaining years with the problem but I am tired of it. .  
 
I have recently had the barium X-Rays (during which the Radiologist could see the barium refluxing), Endopscopic exam, and two Esophagael Manometry tests. All of the Air Force Doctors recommend surgical repair and fundiplication. Surgery is scheduled for the ides of next month but I am still hesitant. What do you veterans think?

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 5011
   Posted 2/27/2013 8:51 AM (GMT -6)   
I'm no service veteran but a veteran to hiatal hernia, including paraesophageal type.

You said part of your stomach is above the diaphragm. That's the definition of paraesophageal hiatal hernia. Did that show on the barium swallow? Or do you have a slider, where the stomach pops up and then goes back down? If a large part of the stomach is above the diaphragm it's called a giant paraesophageal hiatal hernia GPEH which can be life-threatening because it can twist and cut off its blood supply.

Burping isn't important. It that it means that you swallow air when eating, talking, just swallowing saliva. That could be a bit of a pain if you get the surgery, because it's harder to burp and not as complete a burp after the valve is tightened.

Is the plan to do a wrap, a Nissen? If you have weak swallowing it should probably be a modified wrap, like my Toupet - type of Nissen. Or are they only planning on closing the hiatus, the enlarged hole in the diaphragm the stomach goes through? If the valve at the top of the stomach/lower esophageal valve is weak they do need to tighten it, usually with a wrap. This type of procedure has the highest rate of success.

I had the same experience with Nexium as you. It stopped the acid but reflux continued. That means the valve is not working properly. Have you had reflux for a long time, or do you think it may be only because of the position of the stomach? I had terrible reflux when my stomach was pushed into my chest by an accident. The valve couldn't close.

One of the causes of my stomach refluxing was food intolerances/allergies. Surgery didn't cure the other side effects of that, only the ability of the food and acid to get back up into my esophagus. My allergist had me keep a food journal or food log detailing everything I ate and drank and the symptoms. I was able to identify my food triggers and stop my symptoms. Of course stopping allergies didn't cure the hernia! I still needed surgery. I still get tachycardia when I eat something I don't tolerate. You can look up numerous posts on these topics by putting a couple of keywords in the search box at the top of the page.

Trust your doctors' diagnosis. Just make sure you have a VERY experienced surgeon. Outcome depends on it.

Retired Seabee
Regular Member


Date Joined Feb 2013
Total Posts : 129
   Posted 2/27/2013 10:19 AM (GMT -6)   
I began to have super acid reflux prior to going to Vietnam in 1968. I was diagnosed with a possible hiatal hernia at that time and an operation was mentioned but the state of the art was relatively primitive. So they prescribed Donatol and antiacids.

Jumping ahead 40 years, my recent barium swallow showed a large hiatal hernia above the diaphragm. The Radiologist X-rayed me and watched on the fluroscope in the verticle position. When he reclined me to the horizontal he could see the barium refluxing into my esophagus. His written diagnosis said that he noted a moderate hiatal hernia and he recommended surgery. However, during the endoscope it appeared to be much larger.

The General surgeon then personally performed the Endopscopic exam and took pictures of the inside of the hernia. It looks huge to me but.....I had to have two Esophagael Manometrys because they got false readings on the first one. The catheter apparently went down and when it hit the curve of the hernia it doubled back. During the second test, the GI Doctor personally did it and whe it happened again he was able to correct the problem.

The general surgeon is an Air Force Captain and he says that he has performed lots of Nisan Fundiplications. The other day I told him that I was getting cold feet due to some of the horror stories that I had read on the internet. I asked if he could do the hiatal hernia repair without the fundiplication. He said he could but wouldn't recommend it. He still didn't have the detailed reading from my manometry but would be guided by that as to whether he would do the full wrap or the Toupet.

I appreciate your comments and observations.

Post Edited (Retired Seabee) : 3/4/2013 3:59:06 PM (GMT-7)


Retired Seabee
Regular Member


Date Joined Feb 2013
Total Posts : 129
   Posted 3/4/2013 9:23 AM (GMT -6)   
Alcie, you mentioned in another post that they pulled your esophagus down by dissecting it ...can you explain further.....is that redo-able if something goes wrong. Is that standard operating proceedure? My doctor said something about that but it was early in the game and I must have let it slide without further explanation. He is on a short vacation this week and next week is surgery so I would appreciate your personal input.....

Post Edited (Retired Seabee) : 3/4/2013 3:53:36 PM (GMT-7)


opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 3/4/2013 10:15 AM (GMT -6)   
Retired Seabee

Welcome to Healing Well from a fellow Sailor.

That procedure is for if the esophagus is a bit too short to allow for a tension free wrap. Not everyone has to have that done.
What they do is take down the connections around the esophagus and are then able to pull it down some if it is too short. They can even add to the esophagus if it's extremely too short, but that is extremely rare.
I had my last redo after I had surgery to repair a tear in my esophagus and even with all that scarring the surgeon didn't have to pull any of mine down.

If you are having bad reflux I would go with the surgeon's idea to do the nissen also.

Even though your surgeon has done lots of these I would ask him if any have had to be redone. I'm a bit gun shy after having a surgeon who said it was no problem to do the nissen and then he did mine wrong. I had a lot of issues and after almost 3 years a different surgeon found out what was wrong, redid it, and all was good then.

devil
opnwhl4
Moderator: GERD/Heartburn
Nissen 6/06 and 5/09
#3 on 8/24/11

Retired Seabee
Regular Member


Date Joined Feb 2013
Total Posts : 129
   Posted 3/4/2013 4:49 PM (GMT -6)   
I appreciate your input....the resection was mentioned in the initial discussion with two of the surgeons who will involved in the overall treatment but it was not mentioned afterward so I was kind of confused. Few, if any mention about it here in HealingWell either.

I had my last meeting today with my Air Force GI doctor and within the discussion I asked him bluntly if based upon my test results and physical condition if he would recommend that his Father have the operation....he assured me he would....

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 3/4/2013 5:07 PM (GMT -6)   
Retired Seabee

That's a good sign. He is confident he can help you. My surgeon that did my redo in '09 asked me what I wanted him to do when he got in there. He was doing an exploratory surgery because they couldn't pin down any one exact reason I was having the issues. This was right before they were taking into the OR. I told him to do what he would do to his immediate family or what he would want done if he was me.
Almost 6 hours later in recovery he was telling me he was so happy my wife and I kept pushing him to go in and look because it was done wrong and the only fix was a redo.

Sounds like you have a good surgeon to me. I am assuming you are going to a VA hospital for this. Would you mind telling me which one and how your experience has been and is after the surgery? I have been going to Iowa City VA hospital and have had the greatest treatment there. Not for a nissen, but issues from the Gulf War and nerve damage.

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

Andy1986
Veteran Member


Date Joined Dec 2012
Total Posts : 1177
   Posted 3/4/2013 5:28 PM (GMT -6)   
Opn, out of interest what was wrong with your wrap and what problems did it cause?

Retired Seabee
Regular Member


Date Joined Feb 2013
Total Posts : 129
   Posted 3/4/2013 5:50 PM (GMT -6)   
I retired a lifetime ago (32years) from the Seabee Base in Gulfport, Mississippi and will have surgery at Keesler AFB in Biloxi. We don't really have any choice about who will do the surgery but the principal surgeon is an Air Force Captain and he has two Majors (surgeons)available if the unforeseen should occur. Personally, I have no qualms about the surgery....my concern is the recovery... The GI doctor told me today that when my testing started, this was considered to be elective surgery. Now due to the results an my tests, history of reflux and lung problems he considers it to be mandatory if I want to continue with free medical care at military facilities.

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 3/4/2013 11:40 PM (GMT -6)   
Andy1986

I had bad dysphasia, food getting stuck at the wrap. I had to put something like salad dressing, etc on everything to get it to go by.
My first surgeon didn't wrap the fundus around my esophagus like h should have. He grabbed the lower anterior part of my stomach and attached it to the fundus. This caused my esophagus to be at a 90 degree angle until I swallowed, but it wouldn't straighten out all the way.

Here is a link to my story of 3 nissens and an esophageal tear
www.healingwell.com/community/default.aspx?f=45&m=2337138

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

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 3/4/2013 11:41 PM (GMT -6)   
Retired Seabee

Another Mod, Denise, had basically the same problem and the nissen helped her greatly.

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