Toupet or TIF?

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rweintra
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Date Joined Nov 2005
Total Posts : 48
   Posted 11/17/2017 9:08 AM (GMT -7)   
I have been told I have a DeMeester of 236 with almost zero swallowing function. Supposedly the years of acid has affected the nerves and muscles surrounding my esophagus.
My main fear is not being able to belch or vomit which has led me more toward a Toupet, per my surgeon's recommendation. It seems like other options, Nissen/Linx, are out due to my impaired swallowing.

My main GI Dr. now says that TIF could be an option as well. I would like to hear from people who have had either and perhaps had swallowing motility issues to chime in with their opinions.

Happy to answer any questions.

Thanks!

Post Edited (rweintra) : 11/17/2017 9:12:19 AM (GMT-7)


rweintra
Regular Member


Date Joined Nov 2005
Total Posts : 48
   Posted 11/30/2017 2:37 PM (GMT -7)   
Bump!

Really? No one has an opinion?

straydog
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Date Joined Feb 2003
Total Posts : 15332
   Posted 11/30/2017 2:44 PM (GMT -7)   
Rweintra, this forum can be a little active some days or slow others, lol. However, up towards the top on the right is Search. You can type in what you are looking for & perhaps find some threads where this has been discussed. One thing I will offer up, is get a 3rd opinion. The reason is you have two different conflicting opinions.

Good luck with whatever you decide.
Susie
Moderator in Chronic Pain & Psoriasis Forums

rweintra
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Date Joined Nov 2005
Total Posts : 48
   Posted 11/30/2017 2:49 PM (GMT -7)   
Thanks Susie. I’ve received a number of opinions. They’re mostly split. Surgeons opt for laporoscopy, gastros that do TIF opt for that. The Drs that don’t operate at all claim they aren’t educated enough in either to give a definitive opinion so they’re down the middle.

I wanted to check with anyone who may have had a swallowing disorder prior to surgical intervention and what may have (or not have) worked for them.

straydog
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Date Joined Feb 2003
Total Posts : 15332
   Posted 11/30/2017 2:56 PM (GMT -7)   
I wish I could help you but this is out of my realm. But, do keep checking back. There is a member that posts here by the name SharonZ, hopefully she will check in & see your post. She offers up some good info here.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Alcie
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Date Joined Oct 2009
Total Posts : 4931
   Posted 11/30/2017 3:11 PM (GMT -7)   
My concern would be not ability to vomit or burp but being able to swallow past the repair.

I had and still have a "wimpy" swallow according to the doctor who did the testing. My problem was muscular and nerve from having polio as a child. I had the Toupet and did fine. I went to a highly experienced doctor who operated as a team, not individually, in a large university group. I was very confident that I had picked the best group available in my area, highly recommended by my gastroenterologist and well known nationally. I asked about the other types of repair and my surgeon told me what I needed.

Swallowing is not going to get easier after either procedure. Getting all the testing is the important factor in getting it done right for you. It's not a matter or what's popular at the time but what you NEED.

SharonZ
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Date Joined Mar 2014
Total Posts : 1028
   Posted 12/1/2017 7:04 AM (GMT -7)   
rweintra:

I can understand your concern about the inability to belch or vomit, i had a full wrap. My surgeon put it to me this way: How many times have you had to vomit in the last 5 years? I was more than willing to give up vomiting/belching for a chance at a better life. I do carry a prescription of Zofran with me at all times for nausea. A lot of people on this Forum still have the ability to belch, it comes over time. I had an interesting situation just this last weekend. I had a case of severe food poisoning, with uncontrollable diarrhea, profuse sweating and shaking. Then it happened, I started dry heaving and a small amount of vomit came up - but it was very painful. I talked to my surgeon and he said he wasn't surprised because my body was trying very hard to get rid of the poison and should have no effects other than the wrap being temporarily irritated.

I agree about a third opinion and here's why - If you swallowing function is impaired (and you think your impairment is severe), you need to know how good of a candidate you are for either procedure.

Sharon

rweintra
Regular Member


Date Joined Nov 2005
Total Posts : 48
   Posted 12/1/2017 9:29 AM (GMT -7)   
SharonZ, well said regarding how often do you really vomit? I actually have never burped in my life. I've always had growls that have worked their way up and out. I do have anxiety about not being able to vomit even though I haven't done it much per the point you've made. Maybe once per year, if that?

My surgeon let me know that I shouldn't have that issue with a Toupet vs a full wrap. I hope that's the case. He said the 90 degrees that isn't wrapped allows gas and vomit to pass. I wonder if that also allows acid to pass, thus defeating the purpose of even wrapping in the first place.

Alcie, The Drs (yes multiple ones) are convinced that my swallowing function will eventually improve, perhaps dramatically, once the area is void of such massive amounts of acid for such long periods of time. I guess my DeMeester score of 236 tells a significant story.

SharonZ
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Date Joined Mar 2014
Total Posts : 1028
   Posted 12/1/2017 10:43 AM (GMT -7)   
You will be fine, just have them give you an anti-nausea medication to keep on hand. With any type of wrap, there is always the potential for acid reflux. Some people continue to need PPIs post surgery, but I think that amount is small. The surgery won't give you a free card to eat as much as you want, whatever you want, drink in excess - but you know that. You might find there are foods that you don't tolerate as well, it's best to back off of them and try them at a later time. There are still foods at 3.5 years later that bother me, such as steak and salad. I no longer drink any type of carbonation, but that's just me because I felt that it caused too much gas. I started to feel better about 6 months after surgery and like the new me at 1 year. I didn't experience much pain, or gas, with the surgery. It was done via robotics, I'm not sure if that made a difference. My biggest complaint was exhaustion. I was off work for 2 months, and I was fortunate that my employer gave me unlimited time off with pay. The diet that I followed was "UPMC Post-Nissen Diet", you might want to take a look at it - I believe it's one of the better ones out there.

Sharon

rweintra
Regular Member


Date Joined Nov 2005
Total Posts : 48
   Posted 12/4/2017 9:51 AM (GMT -7)   
I have no problem taking drugs post surgery but I'm hopeful I can take Zantac and not PPIs. I've been on them for over 20 years and need to get off of them. Too many bad side effects and long term issues.

I have a pretty wide open diet right now but every food affects me. Glasses of water to sushi to steak to veggies, etc. I get reflux in my throat and sometimes heartburn. Also, I've always growled and not burped so the growls bring the acid up.

Hopefully I won't be out for more than a few weeks. My employer would also pay for longer but I'll go stir crazy if more than that.

straydog
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Date Joined Feb 2003
Total Posts : 15332
   Posted 12/4/2017 11:34 AM (GMT -7)   
R, not sure what you mean about returning to work in a few weeks. Just a word of caution, returning to work too soon may well work against you rather than helping you. You need to allow for proper healing time & it needs to be a reasonable amount of time.
Susie
Moderator in Chronic Pain & Psoriasis Forums

rweintra
Regular Member


Date Joined Nov 2005
Total Posts : 48
   Posted 12/4/2017 12:06 PM (GMT -7)   
What I meant was, returning to work in 3 weeks time. My surgeon says I’ll be out 1-2 weeks which seems short to me. So, I was extending what he said and was figuring 3 weeks at the outside. Does no one return that early?
I work at an investment bank so I’m at a desk all day and travel a fair amount on planes. I’m not doing any heavy labor.

Yellow1955
Regular Member


Date Joined Aug 2017
Total Posts : 78
   Posted 12/7/2017 2:34 PM (GMT -7)   
If you are looking for information on the LINX or TIF procedure, there are journals to look at in this forum. Here’s a thread

Linx Procedure 2017 My Experience

I don’t know about swallowing tests. I didn’t have preoperative tests other than an endoscopy to verify that I had an hiatal hernia. You should check with my doctor for a second opinion before you have surgery. We do not have any unwanted side-effects and are done can lift heavy objects after two months. The doctor does a valvuloplasty and he is located in Celebration, Florida. I had such an easy time of it. I am on this site to try to give people another option. It has been a year for me and I haven’t felt this good in years. My only issue was postoperative inflammation, which went away when I went back on medicine.

Essentially the esophagus is put back in the stomach instead of the stomach poking through the hernia In doing so, a valve is created which opens and closes when you eat. The hiatal hernia is closed with a Vicryl mesh which dissolves during the postoperative period. You fly home after 4 days in the hospital. There is an individual had the procedure, was going back to work part time after 2 weeks of recooperation,.

There are several of us who have had this surgery and here is my thread with research and other threads where people documented their perioperative period. We do not have unwanted side-effects or any for that matter. I wish you good luck because this is a tough problem.

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

If you decide to see him, please document your visit in this forum (positive or negative). Doing so will help others.

Post Edited (Yellow1955) : 12/7/2017 5:00:01 PM (GMT-7)


Sweetie UK
Regular Member


Date Joined Dec 2014
Total Posts : 213
   Posted 12/10/2017 2:08 PM (GMT -7)   
Hi!
I have had toupet op done over 2 years ago for reflux and a small hiatus hernia. Post op - my diet post-op was straight to sloppy foods - so I didn't have to do the liquid diet a lot of people have to follow after the nissen op. All has gone well - so much so that I don' t really visit here so much! I have no acid reflux, I can belch from my toes - but being sick - that's not like it used to be (put a post on here a day or so ago) I can bring up liquid - and flecks of food - but nothing more! Don't let that put you off though. With reflux I used to vomit often - now I only feel like being sick if I pick up a stomach bug - and that's taken well over 2 years! I have no issues swallowing - and I lost the cough that the acid reflux gave me almost immediately after my op. I also have a level bed again! For me the toupet has worked really really well.
Hope that helps!

rweintra
Regular Member


Date Joined Nov 2005
Total Posts : 48
   Posted 12/14/2017 6:26 AM (GMT -7)   
SO good to hear! I'm looking forward to getting it done and over with. January 12th can't come soon enough.

Sweetie UK
Regular Member


Date Joined Dec 2014
Total Posts : 213
   Posted 12/15/2017 12:18 PM (GMT -7)   
Good luck with your op! I should also add I stopped any anti-acid meds straight after my op too. Didn't need them as I wasn't getting any acid anymore! Was off work 3 weeks - just in hospital for 24 hours - the worst part of the op was the shoulder pain from keyhole surgery - but you will be given pain meds for that. Best to get up and walk as soon as you can - it really helps!
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