Weak Motility & Nissen Fundo Question????????

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tracks83
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Date Joined Mar 2008
Total Posts : 149
   Posted 6/20/2013 7:55 PM (GMT -6)   
Has anyone here been diagnosed with weak motility and had a nissen fundoplication performed? If so did you experience dysphagia after the procedure? Was the dysphagia bearable? How long did it last or do you still have it?
Is it possible to still have a reflux procedure even though a patient may have weak motility?

theacidrefluxman
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Date Joined Oct 2009
Total Posts : 739
   Posted 6/20/2013 8:03 PM (GMT -6)   
I also have dysmotility/weak peristalsis/weak motility

I have asked this of a few of what I believe are well-regarded GI doctors. Unfortunately, I have not asked it of surgeons.

I think that in general the idea is that it is not an ideal thing to do. HOWEVER, studies seem to show that those with weak peristalsis haven't had any worse post-Nissen outcomes than those without peristalsis.

Regardless, In the words of one of them, "it is not a strong counter-indication for surgery".

If I were in the market for the surgery, I wouldn't worry about my motility being an impediment. In fact, in some people motility actually seems to come back after the surgery.

As a side-note, according to my GI there are a few drugs coming down the pipeline over the next few years that serve to improve motility.

tracks83
Regular Member


Date Joined Mar 2008
Total Posts : 149
   Posted 6/20/2013 8:18 PM (GMT -6)   
"I think that in general the idea is that it is not an ideal thing to do. HOWEVER, studies seem to show that those with weak peristalsis haven't had any worse post-Nissen outcomes than those without peristalsis."


The studies just don't make sense to me. If I strengthen the LES my motility should get stronger. But if my motility is weak won't the strengthening of the LES exaggerate the weak motility and cause a patient a great deal of dysphagia.
www.tommarkzfilmsblog.com

theacidrefluxman
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Date Joined Oct 2009
Total Posts : 739
   Posted 6/20/2013 9:30 PM (GMT -6)   
Its a chicken/egg thing. I am under the impression that for some people it is a cause of their GERD, while for others GERD has caused it...

It is important to point out that plenty of people have motility issues in the general population and have no issues...its not limited to us. But we have GERD so we find out that we have these issues...

I wish I knew more about motility issues but I get the impression not even Dr's know that much about it...

opnwhl4
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Date Joined Dec 2008
Total Posts : 4961
   Posted 6/21/2013 1:23 AM (GMT -6)   
tracks-

They usually do a modified wrap depending on how bad it is. I have some issues after the esophagus tear and still have a full wrap without any problems. I know Alcie and Joy have the modified wraps and seem to be doing well with them.
With the newer "floppy" wrap food can get past the wrap easier. They used to make the wraps tighter and that would be a problem.

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

Baza
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Date Joined Jan 2011
Total Posts : 513
   Posted 6/21/2013 6:50 AM (GMT -6)   
Hi,ive had a Nissen Fundoplication and had swallowing problems way beyond the healing period and still do.Ive had a dilation which helped a bit but still have problems with certain things.Thats ok but I still have reflux aswell. I believe I had a motility problem that I didn't know about,no manometry was carried out pre surgery.
I would be very careful about surgery if you have a motility problem,make sure you have a top surgeon who knows his stuff.Not like mine!
I was told I had a 360 floppy wrap done,but its so floppy it doesn't prevent reflux.

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 6/21/2013 12:49 PM (GMT -6)   
Baza

They should have done a 270 or 180 degree wrap, but without the manometry they didn't get all the info they should have. Sorry to hear that happened.

I wonder if your reflux issue is food sitting above the wrap. If that happens it feels like reflux.

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

Baza
Veteran Member


Date Joined Jan 2011
Total Posts : 513
   Posted 6/21/2013 1:51 PM (GMT -6)   
Bill,i think your right about a 270 wrap.Im sure its reflux as I have responded to the ppis.I can feel food going through then half n hour to an hour later all my reflux symtoms start just the way it did before surgery. Waiting three months now on results from a different surgeon to find out whats wrong.
Manometry is an extremely important test pre surgery! Barry

Luna Wolfheart
New Member


Date Joined Dec 2013
Total Posts : 12
   Posted 12/8/2013 9:06 AM (GMT -6)   
hello how do you know if food is sat at the top of the wrap? :-)

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 12/9/2013 8:45 PM (GMT -6)   
Luna Wolfheart

Welcome to Healing Well.

In the first week or 2 it's hard to tell when this happens. Once you get to know how things are going down you can feel it sitting there. It's very similar to what you described in the other post. Feel like you need to burp and some comes up your esophagus. Like a bubble.

If what you are eating is cold or hot you can feel this sensation go into your stomach. At your stage in healing I would say you most likely do have food and liquids sitting there. It's just part of the process as things are swelling in there. It helps to take small sips and bites then wait 15 to 30 seconds and take another. Try to feel it going down and through the wrap just below your sternum. Staying as upright as possible helps things go through easier also.
If you do feel something stuck take a small drink of water and wait for it to go all the way down. If it's still there keep trying. The other thing that can happen is what we call a "hairball". Your esophagus will basically reverse itself and bring up anything stuck when you have drank enough. It's not like vomiting, it just comes back up. Room temp or slightly warm drinks are easier to get past the wrap as cold can sometimes cause it to tighten up.

Take care,
Bill
opnwhl4
Moderator: GERD/Heartburn, Kidney disease

Nissen 6/06 and 5/09
#3 8/24/11
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