Esophageal Valvuloplasty instead of Nissen for GERD/Hiatal Hernia/Heartburn

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Flboy32801
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Date Joined Jan 2017
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   Posted 1/24/2017 3:34 PM (GMT -6)   
Hi everyone,

I have been suffering from GERD/Hiatal Hernia now for about 10 years. I'm a 25 year old male and after being on PPI acid reducing medication for 10 years, I have finally found a surgeon that is going to fix my hernia. My symptoms include terrible acid reflux, sleep apnea, asthma, and I think my hoarseness. It's beginning to become unbearable and getting in the way of my everyday life. It's hard to fake not being in pain so I decided to find a permanent solution.

The main surgeries that have been around to fix GERD and acid reflux has been the Nissen and Toupet Fundoplication, but apparently there is a new revolutionary procedure that my surgeon performs, that has no ill side effects like the Nissen. The procedure is going to be done robotically (via the Da Vinci system), and will only need 5 small incisions (4 mm each). The Surgeon then will go in and recreate the stomach valve by putting the end of the esophagus into the stomach about 2 cm and suturing it to keep it in place. He will use sutures to keep everything in place and repair the hernia with no surgical mesh or stitching. The sutures are made of a simple sugar that supposedly bonds the cell's tissues together.

My question is: Has anyone had a Valvuloplasty procedure before or knows of anyone who has? It's hard comparing people's Nissen results to that of the valvuloplasty since they are completely different procedures; however, there is almost no literature whatsoever online concerning the Valvuloplasty.

My surgeon has mentioned that he has a 100% (yep i said it) success rate, and has had no recurrence of hernia or heartburn. I have about 8 days until my surgery and regardless of his success rate, I'm extremely nervous. I have been on Xanax periodically to help with this - but the sooner it comes the more worried I get.

I will keep you all posted on my recovery.

Thanks! turn scool
Wes

Post Edited (Flboy32801) : 1/24/2017 4:10:18 PM (GMT-7)


Alcie
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   Posted 1/24/2017 4:25 PM (GMT -6)   
There is a lot of information online on this procedure, although the stuff from 20 years and more ago is not exactly what is being performed today.

The incisions are the same as for the NF, unless you are having the transoral surgery.

NO stitching? How does the esophagus stay in place when it's been jammed down into the stomach? Maybe he does something I haven't heard of before.

Did you get a second opinion?

Flboy32801
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Date Joined Jan 2017
Total Posts : 17
   Posted 1/24/2017 5:59 PM (GMT -6)   
Hi Alcie,

Thanks for your post smile

The incisions are pretty similar except the way my surgeon does them is create a 4mm slit in the skin in each spot and the robotic arms expand up to 1 CM to fit the instruments. so they don't even put stitches in your skin, the skin closes on it's own with a special glue they created at Florida Hospital.

As for the sutures, my surgeon has a patent on the material they use, I guess it's made of a sugar like material that dissolves; therefore, bonding the tissues together permanently. It seems very advanced but I haven't seen alot of online articles.

I didn't get a second opinion because I went to a few doctor's prior that were terrible. I searched and found him online since he has a really good reputation and is leading provider of this newer procedure.

-Wes

Pat Tall
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Date Joined Aug 2012
Total Posts : 950
   Posted 1/24/2017 9:45 PM (GMT -6)   
Flboy, I looked at the Sages.org site at the actual pictures of this procedure--52 patients over 83 months were listed in this study. . It is new to me. Flboy, a suggestion-- how many of this procedure has your surgeon done? Ask for specific numbers--Ask about how many had complications? What were they. Our family asked our surgeon to furnish names and phone numbers of patients for the same procedure (of course with the patients permission in advance) that we could talk to and ask questions. (I know that the names would be successful patients but very helpful). His nurse called us several days later with names and contacts. We asked when the surgery was done, what the recovery was like and foods and pain etc. then wait a month and call again to see if they are doing well or if anything came up.
This does not mean we are for or against this procedure that is new to us . It's being cautious, Please let us know how you are doing. We will all learn from you and it will help so many on this forum.

Alcie
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Date Joined Oct 2009
Total Posts : 5028
   Posted 1/25/2017 11:15 AM (GMT -6)   
By stitching I meant internal stitching. My NF stitches were just steri-strips. I don't want glue because of allergies. My scars have disappeared completely. I wonder how dissolvable sutures can hold the esophagus in place long enough for it to stay there. I would like to read more on that because my hernia and the wrap sutures are permanent.

Pat gave you some very good advice. My surgeon had done thousands of NF and varieties over many years when mine was done. The success rate was in the high 90 percent range. He works with a team, not solo. My surgery took about 4 1/2 hours because there was a large hiatal hernia.

Best wishes!

Flboy32801
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Date Joined Jan 2017
Total Posts : 17
   Posted 1/25/2017 12:43 PM (GMT -6)   
Hi Pat and Alcie,

Thanks so much for your posts. I don't have specific numbers, but the hopsital confirmed they do about 300 or more of these a year and they have a study about to come out since 2001 with nearly 100% success rate (two people became obese and had recurrent issues) and the surgeon said the Da Vinci robot makes it precise. I think the biggest scare for me is what the robot feels like pain-wise, and what the 24 hours post surgery feels like. I've never had surgery before and I'm sort of a wuss when it comes to pain.

My girlfriend's a doctor and I asked her opinion since the surgery is so new, and she said in medical practice new is usually good. They are able to now see ways around the complications the Nissen Fundoplication causes and its supposed to be the 'new thing'.

As for the sutures, the way the surgeon explained to me is that they will dissolve in the esophgeal tissue and, therefore, create scar tissue or a sort of binding if you will. I'm worried myself about it not healing all the way - but he said he's never had a patient come 'undone'. I'm very active so it makes me nervous that I won't be able to work out for a long time.

Thanks again for your posts. This site helps me cope with my pain blush

Pat Tall
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Date Joined Aug 2012
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   Posted 1/25/2017 2:57 PM (GMT -6)   
Wes, your procedure is new to me and I know you look forward to being well again. Please write frequently with their pre and post surgery instructions to you. Tell us all about it.

The hospital confirmed the number of procedures , but were they all 300 of this specific procedure in ONE year or did it include routine wraps (fundo) in that figure. Did the doctor tell you? How many will be in that 16 year study--you can look up this study as they have to be approved. The Sages study looks favorable--I'm sure you saw it. Were you able to talk with a patient that had the procedure you're planning on-- they should be able to work it out for you--it was very helpful to us and put our mind at ease.

Thanks for the explanation on the sutures, they sound like biological sutures . It's comforting to know that they have never come undone. We will follow you on your journey to feeling better. Let the body heal at its own pace and don't be in a hurry for a workout. Please keep writing. Wish you the very best and you WILL get better.

Flboy32801
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Date Joined Jan 2017
Total Posts : 17
   Posted 1/25/2017 3:12 PM (GMT -6)   
Pat,

Thanks so much for the kind words. My surgeon said he won't do another fundo procedure because of the possible side effects, and that this specific procedure doesn't have any side effects whatsoever. Supposedly the procedure mimics the physiology of the esophagus, and he re-creates the valve how it should be. The 300+ surgeries are all Valvuloplasties; but, I haven't had a chance to speak to any success stories. I will ask about that asap, that sounds like a good idea. I've looked everywhere online but nothing.

Someone said it best on another post, most people won't post when their surgery goes well. That makes it tough for me to find any data to rely on. Guess I will be ya'll's Guinea pig!

Do you have experience with the biological sutures? they are supposed to create scar tissue I guess and seal everything that the Dr. creates, but I'm still worried.

Cheers,
Wes

Alcie
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Date Joined Oct 2009
Total Posts : 5028
   Posted 1/25/2017 5:33 PM (GMT -6)   
I've had several surgeries on various body parts and had several experiences with dissolvable sutures. In some of my surgeries, on a leg and abdomen, I've had bits of sutures pop back up through incisions within days to weeks. I don't know what they were made of, but some were thick and white and some were thin and purple.

Whether dissolvable sutures make a scar I don't know. My non-dissolvable sutures are holding my diaphragm and parts of my abdominal wall together. I have a couple of pieces of mesh in my abdomen, but it's not used near the esophagus because it can cut it.

Many dissolvable sutures are supposed to dissolve within a couple of weeks, but some types last for months.

My main question would be whether dissolvable sutures would keep the hiatal hernia closed. The diaphragm is a strong muscle and there would be tension on any sutures there. Would scar tissue be strong enough to hold permanently?

The vavluloplasty is an interesting alternative to NF. It's not new, as I've read about it in the '80s, but has been updated since then. I hope it will be a better possibility for patients in the future.

Flboy32801
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Date Joined Jan 2017
Total Posts : 17
   Posted 1/25/2017 8:02 PM (GMT -6)   
Oh! The sutures I'm talking about are going to be holding the esophagus in place after it's place into the stomach, and also to close the hiatus after they fix the hernia.

The outside incisions won't have anything covering them, they will use a special type of glue that will dry on it's own after a few days and peel off in the shower. Surgeon told me body won't even require stitches since the incisions are 4 mm long only.

I am concerned about the sutures holding as well over time, but he's done endoscopy's on his patients post surgery and every few years thereafter, and he's never had one fail or recur.

Where did you find the information from the 1980's on it? I'm going to look through some peer reviewed articles tonight to see if I can locate anything else.

As for right now, my anxiety is so bad it makes me sick. What really makes me scared though is the post surgery pain. I've never had a surgery in my life so this frightens me. I'm not sure what I'm going to feel post op, or what.

I assume since I'm going to Florida Hospital, I'll be in great hands. They have an amazing reputation and the facility is all brand new state of the art. I'm going to have a few glasses of wine tonight to take the edge off, hopefully something I will be enjoying again soon without the gerd.


Wes

Alcie
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Date Joined Oct 2009
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   Posted 1/26/2017 6:18 PM (GMT -6)   
Just google esophageal valvuloplasty There are dates right on the brief description of many of the studies.
/www.ncbi.nlm.nih.gov/pubmed/3752383
There are more!

But these old studies weren't done the exact same way they are doing the procedure now. The one above describes a flap, and that's not done anymore, I don't think.

I don't believe much of what I read on forums, but scientific studies are mostly informative.

Those are precisely the sutures I was concerned about. Have you found any other studies using absorbable material for such critical, stressed areas? This is very interesting!

Flboy32801
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Date Joined Jan 2017
Total Posts : 17
   Posted 1/27/2017 8:44 AM (GMT -6)   
Hi Alcie!

I've read most of the ones on google (all I can think about these days) but most have small numbers and some do have that flap valve which isn't used anymore. Surgeon explained it's more like a nipple valve, just the end of the esophagus is "intusscipated" into the stomach at 270 degrees which acts as a valve by not letting stuff splash up, but air can still get out (burp). I found alot of studies on animals that are almost 100% success, but I hate going off of that because animals can't tell you how they feel.

The sutures concern me a bit, but he reassured me they will dissolve and pretty much create scar tissue that will become permanent (will not come apart)

I'm sitting here at work while typing this, smiling because Monday is my last day here as I have a month or longer off tongue turn smile

I'm still waiting to hear back from the hospital though about speaking to someone who went through the surgery and hoepfully will hear something soon. At this point, my anxiety is getting to me and I can't focus on daily activities. But my GERD has done that for the past 10 years so I'm ready to do this.

Cheers,
Wes

msiddian
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Date Joined Nov 2017
Total Posts : 3
   Posted 11/20/2017 6:08 PM (GMT -6)   
Wes, have you had your surgery yet? On Sept. 27 I had the 270 degrees surgery also. The pain has been minimal. I still am not able to eat much, I eat several small meals a day. I would be interested to know how you are doing if you have had the surgery.

Yellow19
Regular Member


Date Joined Aug 2017
Total Posts : 120
   Posted 11/20/2017 10:38 PM (GMT -6)   
I had the “robotic-assisted esophageal valvuloplasty with Vicryl mesh closure of the hiatal hernia” over one year ago and I am doing well. The questions regarding dissolving the Vicryl mesh and sutures are excellent. The mesh is a sugar substance, but I’m not sure how the hiatal hernia stays closed after the mesh dissolves - except that it is healed together. Those are excellent questions to ask Dr Gee. It sounds as though you are researching online and I have a post that gives some of my preoperative research - the name is in quotes above. Actually if you search on robotic-assisted esophageal valvuloplasty, it will come up. Dr Gee has sent a questionaire to his patients (while in Florida), so he knows their status and plans to present the update to one of the upcoming conferences. I did note that his team is presenting another paper at the upcoming SAGES conference.

This post is from January 2017 and in my thread, there is updated information. Wes did have his surgery and he is doing well. There are other individuals who went to see Dr Gee and documented their thoughts. I found another individuals on the FB site (the name is in my thread) and she believes Dr. Gee saved her life. Other than those few people, it is difficult to find people online who had the surgery because they are doing well. I would be happy to answer anyone’s questions because I looked a long time for this type of surgery. My research showed me that the Nissen wrap has so many complications and it eventually fails that I knew I didn’t want that surgery.

Let me know if you have any other questions.

SharonZ
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Date Joined Mar 2014
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   Posted 11/21/2017 7:53 AM (GMT -6)   
Yellow1955

Who are you replying to?

Yellow19
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Date Joined Aug 2017
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   Posted 11/21/2017 12:00 PM (GMT -6)   
Msiddian

cnrage
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Date Joined Oct 2017
Total Posts : 17
   Posted 1/28/2018 2:26 PM (GMT -6)   
Flyboy, is there any way I can get your email? I would love to see where you are now with your recovery at this point (especially the "inflammation"). I'm nearing 3 months at this point. Hope you are doing well

.1nana
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Date Joined Dec 2017
Total Posts : 8
   Posted 2/15/2018 7:09 PM (GMT -6)   
Hi. I had this procedure 2/5 and things are looking good. My stomach was inside my chest upside down.

I have some serious recovering to do.

Flyboy if you are still here- Dr G is just great!

Yellow19
Regular Member


Date Joined Aug 2017
Total Posts : 120
   Posted 2/15/2018 8:54 PM (GMT -6)   
Wow that is great that you had the procedure done. My stomach was up in my chest too. We were close to something bad happening. If the blood supply had been cut off to the stomach, It would have been very serious. After eight weeks, you will be fully recovered and able to left heavy objects. Dr Gee is the best.

Post Edited (Yellow1955) : 2/15/2018 6:57:18 PM (GMT-7)


Searose
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Date Joined Mar 2018
Total Posts : 3
   Posted 3/8/2018 6:24 AM (GMT -6)   
Dr Gee take for surgery High cost Many patients can not pay .. Are there other surgeons performing this surgery?

RRose
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Date Joined Apr 2018
Total Posts : 10
   Posted 5/4/2018 2:21 PM (GMT -6)   
Those whom have had this or know this answer: What is the cost (out of pocket) of Dr Gee doing this surgery?

Is Dr Gee and Dr. Farid Gharagozloo the same person, or two different surgeons?

Thanks

Post Edited (RRose) : 5/4/2018 1:26:42 PM (GMT-6)


Yellow19
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Date Joined Aug 2017
Total Posts : 120
   Posted 5/4/2018 6:28 PM (GMT -6)   
They are the same doctor. Since his name is difficult to pronounce, everyone calls him Dr. Gee. I don’t know what the out of pocket cost is, but it is possible that the office will give you the info.

Desperate Sue
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Date Joined Jul 2018
Total Posts : 5
   Posted 7/4/2018 7:48 AM (GMT -6)   
Hello. I just joined this forum. I was a normal, healthy, VERY active (at the gym every day) person until January 2018. I contracted the flu and my life has been a nightmare ever since. Recovery from the flu took a good 2 weeks. However, even when fully recovered, I knew something wasn't right. My stomach or esophagus was very sore. I couldn't eat as much as I used to. Things got progressively worse to the point whereby I could hardly eat anything.

I had an endoscopy and the doctor found and opened a Schatski ring.He also found a hiatal hernia about 2 cm. Obviously I had reflux but the only time I felt it was if I slept on my right side. As this was easily avoidable, I didn't think much of this problem. After the endoscopy my reflux got progressively worse. It said on the endoscopy report "Possible Injury." Of course the doctor never told me this and I was unaware until I requested a copy of the report.

My reflux got progressively worse to the point where it's non-stop 24/7. The sphincter must be stuck in the open position. They diagnosed me with esophagitis. I was just wondering, please, if anyone knows if the esophagitis inflamation can include the sphincter and if there is any possibility that the sphincter can heal? The doctors give me no information in that regard.

I just stopped ppi meds and H2 blockers. I was on them for about 2 months and they made me so ill I couldn't function. I had neurological symptoms whereby my hands were numb (still are a little), spacey, eyes weren't focusing correctly also joint pain, muscle stiffness and much more. I'm now only on Carafate which is soothing and hopefully healing but doesn't seem to do anything for the reflux. Also use Gaviscon (from UK, ordered on Amazon).

I'm just wondering if anyone has ever had an esophageal sphincter heal and thereby resolve reflux. I realize this is probably wishful thinking. Thanks so much. I hope everyone enjoys this holiday. If anyone told me a year ago I would be in this position I wouldn't have believed them. I had never heard of reflux disease! My life is gone and I am an invalid. Does anyone ever get their life back? I am interested in Dr. Gee i Florida Hospital and his method. I want to go that route. I know there are posts on here about him. I hope people who have had his surgery will continue to provide updates.

Yellow19
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Date Joined Aug 2017
Total Posts : 120
   Posted 7/4/2018 12:41 PM (GMT -6)   
Desperate Sue, I had esophagitis and esophagitis and it heals fairly quickly, about two months. I had a gigantic hernia with my stomach through the hernia up in my chest. Dr. Gee performed the surgery and I feel great. All of us have done well. In my experience the symptoms get worse until you get the hernia fixed. It takes eight weeks to heal from the surgery. You can do everything after a week or so after the surgery except lift. I, as all others, are impressed at how well you feel post surgery. Here is another link that has info online and includes all the links on Healing Well.

Robotic-assisted gastroesophageal valvuloplasty with Vicryl closure of the hiatal hernia- no wrap

Let me know if you have any other questions, but do make an appointment to see him, and then decide what you want to do. It is a big decision, so I wish you the best.

Desperate Sue
New Member


Date Joined Jul 2018
Total Posts : 5
   Posted 7/4/2018 6:04 PM (GMT -6)   
Thank you, Yellow 1955, for your response and on a holiday no less! I hope you feel so well that you are enjoying a barbecue! I'm just wondering, please, if you are actually totally free of all reflux symptoms without drugs? Can you eat anything and everything you want? Is your life completely normal in that regard? I now have constant regurgitation since stopping the drugs. I'm hoping this will calm down but am so worried that this is my new norm.

I live in NY. I contacted Dr. Gee's office by email yesterday and am awaiting a response. I can't call because reflux has taken my voice from me. I only hope I can hold out until everything can be arranged. I definitely don't want the nissen. I'm concerned that it might be months before I can even get an appointment for a consult and then more months before surgery. I still can't believe this happened to me but I guess everyone feels this way.

This is a great forum. It's wonderful to know that I can come here for information, support and understanding. I will try to do the same for others.
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