Nissen 360 Failure. What next? Thoughts/advice greatfully recieved.

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Matt Bird
New Member


Date Joined Nov 2017
Total Posts : 6
   Posted 11/2/2017 5:07 AM (GMT -7)   
Hello Everyone,

My name is Matt. Ive signed up for the forum as I'm in dispair at the moment, and considering my options. Any thoughts or experiences would be greatfully recieved.

I started suffering with severe reflux about 10 years ago. It was actually after having a violent cough during which i felt my stomach herniate. Since then, back in 2007 i've suffered the dreaded reflux (was absolutely fine before).

For years i battled it with Gaviscon and ranitidine but gradually the symptoms got worse and i progressed onto ppis. about 3.5 years ago i thought 'enough is enough' and decided to take my chances with the 360 fundo operation.

My surgeon said the op was a 'success',i couldn't eat properly for 2 months which i know is normal. But also i had bad stomach pains for about a year after. They were of a stabbing nature initially but did gradually receed over time. Also i experienced severe bloating and flatulence which was actually horrific and very embarrasing at times. On a few occassions i passed wind without any real control over it during work. I work in finance and it wasn't ideal for this to be happening during client meeting etc. Might sound funny but it was anything but.

On the other hand though surgery did (temporarily) stop the reflux which i was greatful for obviously.

After the 1st year post op, the bloating and pains did subside a bit, and for about 18 months i had a reasonably good quality of life.

Unfortunately around last christmas (lots of eating and drinking probably caused it) i did feel a bit of pain in my stomach again and in January i started getting a sore throat, since then reflux symptoms have progressed and an endoscopy and barium swallow have confirmed that my operation has come undone, and that my esophagus is inflamed, with legions etc.

Im back on ppi's (Lansoprazole) which seemed to control it for a few weeks, but since then my body seems to have built up an immunity to them, and my throat is just as sore now as it was before i started taking them. I doubled the dose which again worked for a week or so but not any longer.

I can feel a regular gurgling noise coming from my esophagus. My doctor said he could see me relfluxing regularly with the endoscope even when my stomach was totally empty. This gurgling never happened pre fundoplication but seems to be constant now. I've changed diet. Lost 7lbs but it hasnt made any difference. In fact it's got worse. Im currently slightly overweight. If i lose another 7lbs it will push me below 25 bmi so I'm going to try and do that.

Does anyone else have experience of this gurgling?

My surgeon says that he can try a redo, although success rates are far lower 2nd time around!! Also after reading forums it has put me off somewhat as complications seem far higher the 2nd time around too, and the 1st time was pretty bad.

I asked him about Linx and Stretta, he said he'd stay away from Linx at my age as over a long period it wears the esophagus but said in some patients Stretta has worked well. He said effectiveness was lower than Fundoplication and some people don't see any difference, but complications are rare so might be worth a shot before considering a redo.

Anyone any experience of Stretta?

I've been doing a lot of reading on this and it seems that in most cases of chronic GERD, a hiatus hernia is involved. In my particular case pre hernia i had no reflux at all, but then after the bad cough and herniation it was chronic. I appreciate in older people the herniation may occur more slowly over time.

I asked my surgeon why, if it's the hernia causing the problem, can't they just fix that rather than go to the extra length of wrapping the stomach which seems to cause the majority of side effects. Maybe in many cases the stomach wrap isn't needed just a hernia repair? He didnt have an answer and just said the operation has two parts and he doesn't do one without the other.

I know that 360 fundoplication is seen as gold standard but for me it had a lot of faults and the side effects were almost as bad as the reflux. There must be a better less invasive answer that can restore the body to it's original form, rather than wrapping the stomach. Is there any surgical info on just the hernia being repaired without the wrap?

I dont know what to do. My quality of life is very poor at the moment. PPIs are not controlling it. I'm waking in the night despite elevated bed etc. I'm thinking of trying Stretta first before considering a redo, my surgeon doesn't do Stretta so has given me the number of a guy in Exeter called Saj Wahed who he rates highly. Anyone heard of him?

Any thoughts/suggestions would be welcome!

Are there any new procedures in the pipeline? A miracle cure would be nice!

Apologies for the War & Peace, and thankyou for listening if you're still here!

Many Thanks,

Matt.

Matt Bird
New Member


Date Joined Nov 2017
Total Posts : 6
   Posted 11/2/2017 7:58 AM (GMT -7)   
PS. After reading one of the pinned posts on this forum I'd say my symptoms are much more LPR than GERD, although sore throat is severe and chronic cough is terrible etc.

Does this make any difference regards surgery and effectiveness of Stretta etc, I've never heard of LPR before. My docs, surgeon diagnosed it as GERD.

SharonZ
Veteran Member


Date Joined Mar 2014
Total Posts : 977
   Posted 11/2/2017 9:34 AM (GMT -7)   
Unfortunately, I don't know much about the Stretta. I had a large hernia pair in conjunction with my Nissen, and it was a success. My surgeon did tell me that I shouldn't think as my surgery as a free ticket to eating and drinking anything I wanted. Even with the surgery, there's still the ability to have reflux return. In your situation, I would seek a 2nd opinion from a different surgeon before anything else. If you are interested in the Stretta, make sure your insurance will cover the surgery. A number of people have had issues with getting the procedure approved for payment. I did experience the gas/bloating, but I was able to control it with Simethicone. I would try another PPI, you may have built up a resistance to the Lansoprazole.

Good Luck!

statback
New Member


Date Joined Oct 2017
Total Posts : 2
   Posted 11/2/2017 7:02 PM (GMT -7)   
read the threat titled "7 days post op-hiatal hernia/gerd surgery" by Flboy. I think it could be very helpful to you.

Yellow1955
Regular Member


Date Joined Aug 2017
Total Posts : 39
   Posted 11/3/2017 6:08 PM (GMT -7)   
The first thread is called “hiatal hernia repair without the wrap?”. I started a new thread robotic-assisted gastroesophageal valvuloplasty with Vicryl patch of the hiatal hernia. I recommend that you at least talk to my surgeon about this procedure before having anymore Nissen wraps done.

Matt Bird
New Member


Date Joined Nov 2017
Total Posts : 6
   Posted 11/4/2017 12:44 AM (GMT -7)   
Hi all, many thanks for your time replying!

Sharon I have tried Omeprazole as well as Lansoprazole. The latter seems slightly more effective but pretty much the same ballpark. Did you find one to be particularly effective? I think because I'm refluxing pretty much constantly (but only small foamy amounts), they are just easing symptoms rather than providing any long term solution. The endoscopic photos of my esophagus were a wake up call that it's not being managed as it's very inflamed and sore.

Thankyou Yellow and Statback for pointing me to those other threads. This proceedure does seem to make sense to me in that it tries to mimic the natural healthy body rather than wrapping which causes side effects such as gas/bloating etc.

I have a few queries:

How much does it cost? Someone said $100,000.00? I'm in the UK and I'm fairly certain my insurance wouldn't cover that and i would struggle to afford it. A nice trip to sunny Florida sounds appealing though. It's cold and raining here in Wales (UK).

Yellow you mention that you still have some reflux and are still on PPIs? I appreciate my wrap hasn't worked out long term, but will say that post op, despite gas etc i had zero heartburn and was able to go cold turkey on the ppis straight away with no side effects or weening needed, as at the time the valve was strong enough to cope with the acid rebound. Apologies for sounding negative/critical this is not my intention, i just want to learn more. But it sounds as though the new valve in your op perhaps isn't 100% effective? If its working properly you shouldnt really have to worry too much about diet unless you're trying to stay healthy etc, but i think a lot of heartburn foods such as tomato, coffee etc are healthy or do have health benefits. Unfortunately i absolutely love spicy food :-/

Also you mention Dr Gee "creates" a new valve. What is the new valve made from? How does he do this? Do you know of any youtube videos of the procedure? I found watching these quite a helpful, insightful way of learning about the Nissen (although do make me slightly queasy smile

You mention Dr Gee has been in Floroda for a year but has performed 500 proceedures in this time. That's an incredibly high amount of proceedures to do in a year. Assuming he takes a few weeks of holidays and has weekends off he must be doing more than two proceedures a day??? How does he have any time for pre op care and examination etc? It's mentioned that he only sees 'new patients' what does this mean? That if you have issues afterwards he has no time for you/doesn't want to know? High turnover is usually a bad sign not a good one. Ie more concerned about his revenues than his clients and operating a factory type practice with poor aftercare? Again not trying to be negative but i am very sceptical of the medical profession generally and just voicing my concerns after reading those threads.

Many thanks again!!!

SharonZ
Veteran Member


Date Joined Mar 2014
Total Posts : 977
   Posted 11/6/2017 5:40 AM (GMT -7)   
The PPI I got the most relief from was Protonix, but again, everyone is different.

Yellow1955
Regular Member


Date Joined Aug 2017
Total Posts : 39
   Posted 11/6/2017 4:22 PM (GMT -7)   
Matt Bird, I don’t blame you for the questions. Look at my new thread called “Robotic-assisted gastroesophageal valvuloplasty with Vicryl closure of the hiatal hernia”.. There are some links that may answer your questions. There is a You Tube of the operation and abstracts submitted to Medical Journals.

Dr Gee only sees new patients because he has Nurse Practitioners who sees the follow ups. It is common in the United States for surgeons to have support staff. However, he did see me when I had many questions postoperatively. It is my understanding that when Dr. Gee puts the esophagus back into the stomach, a valve is created.

I look at it the opposite way. He does lots of surgery, so he is experienced. I didn’t have a poor postoperative period. As a matter of fact, everyone takes excellent care of you. He has a large team, and each has their area of expertise. I am still on PPI’s because my I had a death in my family. My found out that he had cancer when I had my operation, and passed away six months later. I had a unique situation which gave me severe inflammation in my stomach and esophagus. I want to wait to ensure that my stomach is clear before I go off PPI’s, but everyone is different.

Oh BTW, Dr. Gee gives you a DVD of the operation and an operative note. Do email his office because there maybe surgeons available in the UK. Good luck.

Yellow1955
Regular Member


Date Joined Aug 2017
Total Posts : 39
   Posted 11/6/2017 4:30 PM (GMT -7)   
Matt Bird, I don’t blame you for the questions. Look at my new thread called “Robotic-assisted gastroesophageal valvuloplasty with Vicryl closure of the hiatal hernia”.. There are some links that may answer your questions. There is a You Tube of the operation and abstracts submitted to Medical Journals.

Dr Gee only sees new patients because he has Nurse Practitioners who sees the follow ups. It is common in the United States for surgeons to have support staff. However, he did see me when I had many questions postoperatively. It is my understanding that when Dr. Gee puts the esophagus back into the stomach, a valve is created. Here is a quote from his website;
“Robotic-assisted gastroesophageal valvuloplasty recreates the normal anti-reflux barrier valve between the stomach and esophagus. ... As little as three weeks following surgery, many patients report little to no acid reflux symptoms. The minimally invasive procedure is performed through small incisions in the abdomen.”

I look at it the opposite way. He does lots of surgery, so he is experienced. I didn’t have a poor postoperative period. As a matter of fact, everyone takes excellent care of you. He has a large team, and each has their area of expertise. I am still on PPI’s because my I had a death in my family. My brother found out that he had cancer when I had my operation, and passed away six months later. I had a unique very stressful situation which gave me severe inflammation in my stomach and esophagus. I want to wait to ensure that my stomach is clear before I go off PPI’s, but everyone is different.

Oh BTW, Dr. Gee gives you a DVD of the operation. Do email his office because there maybe surgeons available in the UK.

Email link: https://www.globalroboticsinstitute.com/en/contact
Good luck.

Post Edited (Yellow1955) : 11/6/2017 4:33:05 PM (GMT-7)


Yellow1955
Regular Member


Date Joined Aug 2017
Total Posts : 39
   Posted 11/6/2017 4:44 PM (GMT -7)   
Look at this link. The author called DR. Gee’s office and got lots of information.

‘Failed Nissen - valvuloplasty next?’
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