Outpatient Nissen

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CaryF
Veteran Member


Date Joined Nov 2007
Total Posts : 505
   Posted 11/14/2013 11:07 AM (GMT -6)   
I am having an NF 11/25.  My road to this procedure is pretty much the same as every one else's here, years of discomfort, taking Dexillant, Omeprazole & Pepcid, modified diet.  
 
The difference is that my procedure is going to be outpatient. I check in at 7AM, procedure is at 9AM,
I should be ready to go home by noon.  
 
I've read posts from some of you stating that this is a major surgery, whereas my Dr. refers to it as a procedure.
It takes an hour max to complete.  I am planning to take 1 week off work. 
 
It is my understanding that this is not major surgery but a rather simple procedure. The recovery is complex and requires a strict diet, but I should transition to a regular diet in 4-6- weeks barring no complications.  My Dr. does these every day and has performed over 1K of them. My insurance will not pay for inpatient anyway.
 
Am I missing something?
 
Thanks, Cary
 
 

TonyG
Regular Member


Date Joined Apr 2013
Total Posts : 254
   Posted 11/14/2013 1:20 PM (GMT -6)   
Hello Cary,

In my research I read a case study on the New England Journal of Medicine about the Nissen being done as an outpatient procedure. From the outside, one could argue that because of the laparoscopic approach that it could be an outpatient procedure. As someone that has had the procedure done, I would disagree (and I'm sure others here might, too) that this is an outpatient procedure. My Nissen ended up taking 4.5 hours because of the degree of scarring and raw tissue around my esophagus as well as a couple of what are considered "routine" complications that needed additional intervention (torn gastric vessels and a collapsed lung from a small puncture). My surgeon is well versed in the Nissen procedure and as a thoracic surgeon, has done 1000's of these as well so I was very confident in his skills. Given my recovery, I stand by that statement.

That said, the thought of going home the same day as my "procedure" (who are we kidding, it's major abdominal surgery that involves realigning your digestive system...but what do I know) makes absolutely no sense to me. I was in the hospital for a total of 3 days and was out of work for a total of 4 weeks. I would argue strongly against returning to work 1 week later. Knowing how I felt, I wouldn't have wanted to go anywhere near my desk job as sitting up straight for extended periods of time was exhausting.

Regardless, I wish you all the best in your recovery. This forum was extremely useful to me in my recovery and as I was planning for the procedure. Ask as many questions as you want...that's what us folks that have lived through it are here for!

-TonyG-
-TonyG-
Nissen Fundoplication April 30, 2013
Pain-Free, Reflux-Free, Sleeping on my back!

DOGGBONES
Veteran Member


Date Joined Apr 2012
Total Posts : 707
   Posted 11/14/2013 1:36 PM (GMT -6)   
I'm a long time member here and have read many many post, I can assure you the nissen surgery is NOT just another procedure. I'm sure just about everyone here will agree. You may want to ask more questions from others here and your doc as well.

StephanieJean
Veteran Member


Date Joined Jun 2013
Total Posts : 500
   Posted 11/14/2013 2:08 PM (GMT -6)   
I personally think you need at the very least an overnight stay at the hospital. I spent two nights and was thankful for it.

I also took 3 weeks off of work and thought I could have used one more. Some people are fine going back to desk jobs sooner, like at 2 weeks, but really you are at max swelling then and its hard to get enough to eat to stay focused. I was sooooo tired and run down I could have never dreamed even trying to work half days at 2 weeks out.

lajenner
Regular Member


Date Joined Jul 2013
Total Posts : 349
   Posted 11/14/2013 4:16 PM (GMT -6)   
Where are you located?

Honestly, I didn't feel any better 24 hours after surgery when they sent me home, then I did several hours after surgery. I just hope you won't be alone. It would be good to have an alarm set for pain meds, take them on a regular schedule for the first 48 hours or so. I suggest having the liquid narcotics at home prior to leaving for surgery. That way you won't have to deal with it afterwards. I had a very long drive home, the meds had warn off and I was miserable. If you can avoid that, I think you will be ok - as long as someone is with you.

My sinus surgery was a lot more painful, and they didn't keep me overnight.

I think one of the main reasons for the overnight was the surgeon wanted to make sure I could swallow pureed foods alright. That meant mashed potatoes at noon the 2nd day. As soon as I proved I could swallow a little, they started the paperwork for discharge. Maybe there are other reasons, I suppose watching for complications. Oh, another one is they want to make sure you can pee. The anesthesia messes it up, it's tough to get a stream going. An experienced surgeon (like yours) will know before the surgery is complete that it went well.

Personally, I would not have been comfortable working all day until I was 3 weeks post-op. At 1 week, you will still need a lot of rest.

Good luck and let us know how it goes.
Laurie
Nissen Fundolplication Sept. 10, 2013

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 5028
   Posted 11/14/2013 7:08 PM (GMT -6)   
Outpatient? I'd get a second opinion. Also, the doctor can call the insurance and insist that due to your condition (find something) you will need at least an overnight stay.

Patients should not be treated like sheep, and we shouldn't act like them either.

Baza
Veteran Member


Date Joined Jan 2011
Total Posts : 513
   Posted 11/15/2013 4:14 AM (GMT -6)   
Hi Cary,no way will you feel up to going home that soon! Please get a second opinion,you don't have to rush to get this surgery,take your time and find the right surgeon. Barry

CaryF
Veteran Member


Date Joined Nov 2007
Total Posts : 505
   Posted 11/15/2013 7:36 AM (GMT -6)   
WOW! Thanks all for you input. I am calling Dr. today with questions. I will ask for at least an overnight in hospital.

I am in Melbourne FL scheduled to get the NF 11/25 at Holmes Medical Center, Dr. Mark Fusco. I have a prescription for liquid Lortab. Do you agree the major complaint after wards it pain? Thanks for the tip about taking it before the NF.

I am a freelance technical writer and work a lot from home, my time is pretty flexible. I can pretend to be working when I'm not if necessary, but can't miss deadlines.

I rushed this up because I am in the group who's insurance got cancelled, but now I see it might be reinstated which would give me more time to prepare. I am totally ready for relief as I am belching food into my sinuses. (was treated for 2 years as allergies & sinus infections. I also have chronic cancer sores due to high acid.

THANKS Again for the great feedback, I feel more confident to advocate for myself now.

CaryF
Veteran Member


Date Joined Nov 2007
Total Posts : 505
   Posted 11/15/2013 9:01 AM (GMT -6)   
My Dr. (his nurse) says 70% of his NFs are currently performed outpatient without complication, with an average hospital stay of 2.5 hours. In 2014 the goal will be 90% outpatient with an eye in the future toward 100%. There are incentives in the ACA (Obamacare) to dramatically reduce hospital stays and associated cost. Hospitals make little money on outpatient procedures & love to admit people, however, beginning in 2014, all laparoscopic procedures/surgeries, not just NFs, will be performed outpatient as the default. There must be a medical necessity to do otherwise (according to BCBSFL). The goal is not to admit people to hospital in the first place.

I do not present any medical reason/necessity to have the NF performed as an inpatient. BCBSFL
will not approve an inpatient stay for the NF in my case. I did not have my ducks in a row to argue for an inpatient procedure. I have no option.

I am prepared to feel crappy and follow a strict diet. I have a driver as required.

I'll let you know how it goes. Apparently, I will be ready & allowed to go home after I pee & prove I can swallow. Its all about insurance. Y'all must have better insurance than I do to be admitted for the NF.

Thanks again, Cary

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 11/15/2013 10:27 AM (GMT -6)   
Hi Cary,
I will tell you this.  By the next morning, I couldn't WAIT to get out of the hospital, and was frustrated that my surgeon didn't come in until 10 AM.  Hospitals aren't the best places to recover, and when there are no complications, home is a better option.
 
That said, I'll tell you what I received at the hospital overnight:
 
1.  Advice from the night nurse to get up and walk whenever I went to the bathroom (which I did...walking laps around the hallways each time)...very good advice to take home with you.  It will help get the gas moving out, and reduces the pain in your shoulder (yes, shoulder pain...it's generally the worst of it).
 
2. IV pain meds in the beginning...probably liquids as well, since you won't get a lot via mouth  for a while, due to the immediate trauma of the surgery/anesthesia.  Still, you can sip on water and swallow it down.  The swallowing is a little strange and painful in the beginning, but it works.
 
3.  They switched me to oral pain meds the night before I went home to be sure that they were working, and they could adjust them before I left. You can just call from home if the pain meds aren't doing the trick.
 
4.  Just wondering if they'll give you a barium swallow test, before sending you home...I didn't get one, but there are a few here who had surgeons who require them before taking anything by mouth.  I was just wondering that if they send you home, it will be something they want to do.
 
5.  They brought me "no-no's" on my tray...caffeinated coffee, carbonated soda, and a straw (carbonation and straws introduced more air into your stomach and increases bloating)!  All not the best for early recovery eating/drinking. The only thing they brought that worked with lemon ice, which was yummy, and fine to eat.  At home, you'll obviously have more control of your eating/drinking choices.
 
Honestly, I do think it's fine to go home right afterward. Obviously, the only purpose of the overnight or several day hospitalization is if you have a complication.  You will have to self-monitor and call your surgeon's office day or night if you have a concern.  I'm sure they're expecting it, and if you're a responsible patient you will do that.  You know your body, and if something seems seriously out of whack, give them a call.  Don't hesitate to get back into the ER, either. 
 
If you read lots of posts here, you'll get an idea of what to expect, so you'll know if you're out of the norm.  This forum will be especially important to you in the first few days.  You'll be able to post your experience  and concerns, and other Nissen members here can share their thoughts about them.
 
Here's my early recovery journal.  In my case, I could have easily recovered the first night at home in more comfort than the hospital.  Just listen to the advice of others here.  Read, read, read, and prepare yourself completely.  You'll do fine.  Here's the link to my recovery journal:
 
 
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

Post Edited (dencha) : 11/15/2013 8:33:26 AM (GMT-7)


lajenner
Regular Member


Date Joined Jul 2013
Total Posts : 349
   Posted 11/15/2013 11:23 AM (GMT -6)   
Working from home, at your own pace - should be fine the 2nd week. The first few days after surgery, it's difficult to get interested in anything. By day 5, it improves.

I'm glad Denise feels like I do, you'll be fine in your own bed. I know I would have been. I just hope you have someone to spend the night with you, just in case - or to help you get your lortab when it's time.

Put your surgeon's phone number in your phone - so it's ready if you need it.

I've done really well throughout my recovery. You can read my journal here:
http://www.healingwell.com/community/default.aspx?f=45&m=2847294

We'll be here for you when you get home! :)
Laurie
Nissen Fundolplication Sept. 10, 2013

CaryF
Veteran Member


Date Joined Nov 2007
Total Posts : 505
   Posted 11/15/2013 11:37 AM (GMT -6)   
Thanks for your support and guidance Denise, much appreciated. Yes, I hear you loud & clear about the walking & intend to follow your advise. I walk my dog on the beach daily & she expects it so no slacking there.

All other points well taken, thx! I will be prepared with jello, tea & broth.

I did a barium swallow test a few weeks ago. It seems like an awful lot of drinking right after surgery.

I have been given a pager number to call immediately with any complications.

Thanks again all for sharing your experience and for your great suggestions.

Cary

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 5028
   Posted 11/17/2013 3:07 PM (GMT -6)   
It's standard that after outpatient surgery the patient needs to have someone in the home with them.

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 11/18/2013 1:13 AM (GMT -6)   
CaryF-

I too am worried you won't have the barium swallow after surgery to be sure there are no leaks. I wasn't allowed to eat or drink anything until I had this done.

A procedure to me is something like an EGD, maybe a knee scope, but this IS major realigning of your stomach and such. Even o]if your insurance doesn't want you to be inpatient, if you have any issues that require you to be admitted that all changes. Anything from pain control to any major complications can cause the doctor to admit you.

I had a spinal cord stimulator implanted at the VA last Feb. and it was supposed to be an outpatient, but I was admitted for 4 days for pain control. So don't write off the possibility of being admitted if medically necessary.

If you have any issues that aren't addressed before you do go home, be you own advocate and make sure they give you all the answers you need.

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

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