Thanks very much for the extensive update. Very helpful for all of us grappling with this condition and how best to remedy it. You provided a lot of important details.
A significant takeaway is that this procedure is not a simpler alternative to the others, as one may think. Arguably that's understandable, given the additional work enabled by using the da Vinci and presumably the more complex physiology change. This is consistent with the hospitalization being 3-5 days, whereas with the various fundo's it is usually only 1-2 days. Of note is that Dr. G's reported results from the Univ of AZ was a median 2 days, so that's increased; hmm. And the average surgical time was ~3 hours, also an indicator of the complexity.
In this vein, the recovery/adverse effects are quite interesting as well. The lower-digestive effects which can cause bloating and dumping syndrome, as well as the the dysphagia, are very common complaints following fundo's and especially with the latter, with the Lynx (which I had). Interestingly, again in the UA results, there were no reports of gas bloat or long-term dysphagia, so perhaps the staff needs to give the cautions even though those complications are unlikely - that's something to inquire more about
(it could be due to how litigious we've become). I wonder, did the doc/staff say anything about
any patients ever needing a follow-up procedure to resolve such complications (as is true with all the alternative surgeries)? With these issues it's important to know what causes the adverse effects, as they are not always the same between the various surgeries.
Did staff indicate how much weight loss to expect? I've been told 10-15% of body weight. Four weeks w/o solid food can do that.
The longer-term esophageal inflammation I presume is to be expected given again the more extensive reconstruction. Like you, I have a very difficult time with ppi's. Over the last 5 years I've become a layman expert on the pharmacology of all
of the ppi's and H2 blockers. And I've used carafate many times as well, which is a real PITA scheduling doses especially if you use other meds. (Please feel free to ask about
any of these, they are *not* all the same and sometimes efficacy/adverse effects can be better managed with different dosing regimens, etc. - if you do ask, tell me your ppi adverse effects.)
So you only had *one* incision??? Very interesting; the UA report shows 5 ports.
Especially of interest for myself is your comparison of the valvuloplasty with the Hill. I've struggled with understanding the mechanical and physiological differences. I know that, as with fundo's, there are variations in how surgeons do the Hill. There are sources that claim the Hill is a "legacy" procedure, although IIRC it is still used at Swedish in Washington State where it was developed, and there is a surgeon near where I live who prefers it over the Nissen. That said, the Hill appears to be a different method of getting the result from a Toupet, i.e., a 270 degree posterior wrap. The UA report shows the valvuloplasty also being 270 degrees. The difference may be in that the Hill and Toupet are created by pulling the stomach fundus up around the esophagus, while it looks like with the valvuloplasty the esophagus is actually pushed into the stomach and closures are made both posterior and anterior. I've read that a minimum length of the esophagus is a prerequisite for the Hill, possibly also the valvulosplasty? If I sound like I know what I'm talking about
, rest assured, I don't.
Great to know other surgeons are using this procedure. Although Philly is farther for me than Orlando.
Thanks again for the fantastic post, @nick_umm. Please continue to share what you learn and about
your recovery and results. There is just too little information available for people to make informed judgments.