Any toupet-er's out there?

Hi everyone!   My name is Jon and I'm 24. I live in the UK and have suffered from reflux and oesophagitis since the age of 18. I've lurked on this forum from time to time over the past couple of years since considering surgery but haven't posted until recently.   I've been on medication for my reflux since I first had symptoms; this has ranged from simply Raniditine twice daily all the way up to Pantoprazole 40mg twice daily and Metoclopramide/Domperidone 3 times daily. I had an endoscopy about 2 years ago which revealed a 3cm sliding hiatus hernia and grade A oesophagitis. Things have calmed down a bit these days due to actually looking after myself, and in terms of severity my reflux was actually pretty low from my last pH test (16 Demeester score).   I mainly experienced the worse end of my symptoms due to me being young and stupid for a number of years and refusing to change my life style (smoking and heavy drinking being the main cuprits!). This has now unfortunately left me with reduced motility and my GP was pretty keen on me going for surgery as being on PPI's and such for the rest of my life didn't really sit well with either of us! Long story short, I'm scheduled for a Toupet fundoplication this coming Tuesday (3rd of Feb) and was wondering if anyone could shed some light on a few things for me. From what I've read most people tend to be getting the standard full Nissen, I assume due to their reflux and symptoms being far worse than my own, and I haven't really seen much on the 'looser' wraps (Nissen not being an option for myself due to motility of course). Some sources, (including my surgeon) state that the Toupet has been found to successful in eliminating reflux almost as much as the standard Nissen and the return to a regular diet being a lot quicker. I've also read burping and vomiting causing no problems and less reports of bloating post op. On the other hand, what posts I have read regarding the Toupet recovery have both confirmed and denied all these! I guess what I really would like is some first-hand information from anyone who has, or knows anyone who has undergone the Topuet or any other partial wrap in regards to recovery and side effects. Sorry for waffling on a bit. I'd really appreciate any insight you guys can offer me!  

Hi Jon,
I am having same as you - in UK in March - 270 is supposed to cause less problems than the full 360. I can't comment any more as I am still waiting to get there! Are you having this done as day surgery? I am. Can't wait to ditch my tablets as they make me feel almost as bad as having full blown reflux!

JB and Sweetie - Try to get to stay in the hospital at least overnight. This is major surgery! Nobody should go home until it's safe to do so. If you're going to have trouble it will probably be overnight or the next day, and then how will you rush to the hospital? You won't be thinking for yourself and won't be able to swallow pain meds right away. They make us NPO for 24 hours for a reason.

I've had shoulder surgery twice (among many other surgeries) of which one was outpatient and sinus surgery outpatient, which were bad enough. Fundoplication is much more involved and there is a lot more that can happen. You just can't take care of yourself for at least a day.

I know there are plenty of patients who have gone home the same day, but it's not safe! It's illegal (in USA) to force new moms to go home the same day. This is as bad or worse!

As far as I'm aware mine is overnight, or so I've been told. There aren't many cases that I know of where they send people home straight after such major surgery and general anasthetic, that would be pretty reckless!

That being said, working in the NHS myself I'm very aware of the current and constant pressure for beds and unless there's a real concern from the surgeon that I should stay in, I'll be out of the door as soon as I'm physically able. Aside from the reflux I'm young, healthy and quite physically fit so fingers crossed it will be the next day!

Post Edited (JB_The_Great) : 2/1/2015 7:34:59 AM (GMT-7)

Hi Jon my touplet was done on Tuesday in the uk. I can most definately say it cannot be a day case. I was in 3 days and needed all of them. A barium meal is done 24 hrs after to check op has no problems how do you do that at home! Also you are on IV drip with glucose, paracetamols, anti-nausea given. No way could you swallow these at home. Have a rest my surgeon said its a major op, so true!

Thanks Reet, that's exactly the sort of info I was after. 3 days? Were you in pain/tired/sleeping a lot? Were you out of bed all the time or resting? Is paracetamol enough for the pain then, I can't stand taking opiates!

Sweetie, that doesn't sound right at all! I know it's not the biggest operation in the world, but for heaven's sake they're moving a major organ and stitching it up somewhere else!!! I was even in 2 days when I had my appendix out, which was open rather than keyhole. I actually had to go back in the day after because I couldn't stop being sick!

Thanks everyone for good wishes. Barry I was in Derby Hosp under Mr Leeder. Alcie the paracetamol IV is so much stronger than going through the stomach and as soon as one bag was finished I was hooked on to another to keep up flow. Jon I spent the first day trying to stop heaving hense the anti-nausea drip I only managed sips of water but found I could not tolerate anything cold, the pain radiated around my back. From then on I drank or rather sipped warm flavoured water. Day 2 only heaved 3 times been ok with that since. I have been given disolvable paracetamol but hav'ent needed them, when the pain comes I stand or walkabout, lightly burb and it passes. 3 am last night was worse it took about an hour but then I was fine. I slept off and on all the first day and only left my bed to visit the loo. Anymore questions I will try to answer will be thinking of you on Tuesday. Good wishes Rita

Just a heads up to anyone whose interested; my surgeon was one of the first to implant the LINX device in the UK, and informed me that's he's very recently received authorisation to offer the procedure on the NHS! I'm not a candidate due to my crap motility but this is exciting news for anyone from the UK and not wanting a wrap!

Yep it's all done, had it about 4pm yesterday. I can burp straight away so I'm really pleased, but the gas in my abdomen is really painful. Most of all though I'm starving, I haven't eaten for 2 days! Currently waiting for the surgeon to come round and see if I can go home today, I really hope so!

Should be going home this evening, I managed a cup of tea and a yoghurt but it took me 15 minutes as every swallow was very painful! It just feels like inflammation from the wrap, the gas pains may have subsided but my belly is still swollen as hell! Apparently my oesophagus was way more damaged than they thought and they had to move it? I'm not too sure, the tramadol is making my brain fuzzy!

Yes I'm home now, but I'm unable to manage without pain killers. Everything I swallow seems to have trouble getting past the wrap, however it goes through after a couple of seconds. I'm eating mostly baby food, that stuff is tasty haha! I'm going back at the 4-6 week mark to see the consultant but I haven't got a date yet. I'm also going to get hold of some lactulose or something similar since I haven't even passed gas yet and I've been on a lot of opiates.

What happened with your upset stomach if you don't mind me asking?

Edit: So now there's a new development, nausea! Even with mouthfuls of liquid I seem to be feeling very sick from every swallow, it feels like stuff is getting stuck. I know this is normal but I'm bloody starving!

I've spoke to my doctor's surgery and they're going to sort me out with an anti emetic so hopefully I can eat today.

Post Edited (JB_The_Great) : 2/5/2015 4:51:10 AM (GMT-7)

Just a quick update for anyone who's still interested.

I'm currently a week post Toupet and I feel great! The nausea only lasted for that day and I didn't need to get an anti-emetic. I've been medication and reflux free since my operation and most importantly the side effects from the meds have gone! The gas from the operation and digestive wind inside my abdomen caused me the most problems, but after the 5th day it had almost resolved itself. The problems with swallowing and things getting stuck seemed to ease around this time too, to which I'm sure it was all related to the wrap being swollen.

I'm surprised myself, but I'm almost back to a normal diet now. I haven't dared try any meat yet but I reckon I'll be there by the end of the week. My only real problem has been with one of the incisions that goes straight through one of my abdominal muscles, which causes problems getting up (and particularly initiating bowel movements) but that will heal in time. I even made it down to the pub tonight for a couple of pints! (Ale though, no carbonation yet!) I was taking a decent amount of Codeine most days, but due to past experiences with opiates I was mega-dosing lactulose along side. God only knows what would have happened if I hadn't, my first movement took a week and wasn't easy!

I guess I've only got my surgeon and the NHS to thank for my recovery and doing such an amazing job, I can belch just fine and have no problems swallowing although it is early days yet. I want to thank you all for your support in this thread and all the information I've read throughout the forum. It certainly prepared me for what to expect post surgery. I guess I'm just thankful a partial wrap was all I needed. I really feel for you all who have to have the full Nissen done. I can't imagine going through all this for longer than I did.

Thank you all again, and heal well!

Prior to my operation I hadn't actually eaten bread in over 6 months. I was fairly active and quite into weight training so my diet was very clean, no refined carbs just meat, fruit and veg. No dairy either, so my current diet of milk based things and sloppy carbs isn't exactly where I want to be! Due to the damage to my oesophagus I struggled to swallow bread anyway so I assume that will always be the case. As you can guess, really missing eating meat especially beef but I should be there soon!