Nissen Fundoplication

My surgery went very well, and I'm so glad that I had it done! I don't have to sleep sitting up anymore. I don't have to avoid certain foods anymore. I NEVER have heartburn/GERD.

Here's how it went:
• My husband and I flew into Rochester on a Sunday.
• The next day, I had a pre-op appointment with my surgeon and a PA, and I did my pre-surgery labs. (They also had me do one imaging test to check the functionality of my esophagus because some of my tests the August before indicated that it didn't always function properly, but they found that it does.)
• The surgery was on a Tuesday, and I was discharged Wednesday afternoon.

Mayo will allow you to fly home the same day you were discharged if you want to. I chose to stay until Saturday.

They will give you food guidelines because you can't just eat normally right away.

The follow-up imaging is done at your home location, and you then mail Mayo a CD of the imaging. After they review it, they will call you for the follow-up appointment.

Weirdest thing is that most of the pain was in my shoulders afterward despite that I had five abdominal incisions. Apparently, this is normal because while performing the surgery, they fill your tummy up with gas (CO2, I think). They only way for the gas to dissipate from you body is for it to rise up to your shoulders. They will give you pain meds for this. (I can't take pain meds, so they put some kind of warming device on my shoulders, and when I was back at the hotel recovering, I used ThermaCare.)

I would not go to a general surgeon for this. Here's why... they needed to detach my diaphragm, esophagus, and stomach and move them about two inches lower. They then tack everything down, and then they perform the wrap of the stomach around the base of the esophagus. (If the esophagus is performing correctly, which they figure out via an imaging test called an esophagram prior to the surgery, they will do a 360º wrap of part of the stomach around the base of the esophagus. If the esophagus doesn't, then they perform a 270º wrap of the stomach.

I believe what you want is a thoracic surgeon.

Have you been to Mayo before? They will likely want you to meet with a GI doctor first, and they will then order testing and maybe some labs. You usually don't get to choose which doctor you get, but that's okay because they are all great.

I see Dr. Jeffrey Alexander in GI. He then finds a thoracic surgeon. My thoracic surgeon is Dr. Francis Nichols.

I first met Dr. Alexander in January 2016.

I had a follow-up with him in August, and at that time he said that I was now a candidate for the surgery because I had lost some weight, was healthier, and they had also learned that I cannot take PPIs due to genetic issues. He asked if I could stay a week longer to do the testing and have a subsequent follow-up with him and the surgeon because I lucked out and another patient had just cancelled all of these same appointments I needed.

At the follow-up, I met with him again, and then he pulled a thoracic surgery PA and Dr. Nichols into the room. We talked everything over, and Dr. Nichols then pulled his schedule/calendar up on the computer screen and we picked a surgery date.

Thank you for the all valuable information. I've heard horror stories if they wrap too tightly its impossible to vomit. Have you ever heard that?
Is an esophagram where they give you a drink and then they x-ray you as you swallow it? My gastro never mentioned any problems with the esophagus.
I guess its this very large hiatal hernia. Oh it must have been terrible not to be able to take pain meds for the shoulder. Did you have any pain in the stomach
area or diaphgram area? Did you have a problem swallowing after you woke up from surgery? Please excuse all my questions. I'm so petrified
to have this done. May I ask you a personal question? Would you be able to give me the name of the surgeon that performed this surgery
Again thank you for the information.
Regards,
Caress

No, I have never been to the Mayo Clinic<br>I hope what you say is true, that they are all great<br>Don't need any mistakes or problems at my age, I'm 75yrs. old<br>This hiatal hernia never ever bothered me only having the heartburn<br>Its only been bothering me on and off for the last year. I get very weak<br>and no energy, I think I'm losing blood, so my gastroenterologist wants<br>me to have a colonoscopy which I haven't done either. <br>Not crazy about the prepping for it.<br><br>Do the doctors mention to lose weight, before surgery? I've been trying for years without success.<br>How are you feeling now? Are you happy you went thru with it?<br><br>Let me know, thanks so much for the information<br>Regards,<br><br>Caress<br><br><br>--------------------------------------------<br>On Wed, 2/15/17, Mayo Clinic Connect wrote:<br><br> Subject: @kdubois replied to I'm scheduled for Nissen Fundoplication surgery @ Mayo next Tuesday...<br> To: barpet63@yahoo.com<br> Date: Wednesday, February 15, 2017, 12:49 PM<br> <br> .<br> Mayo<br> Clinic<br> ConnectReply<br> by @kdubois<br> in Digestive<br> Health on Wed, Feb 15<br> <br> Reply<br> I believe what you want is a thoracic surgeon. <br> <br> <br> <br> Have you been to Mayo before? They will likely want you to<br> meet with a GI doctor first, and they will then order<br> testing and maybe some labs. You usually don't get to<br> choose which doctor you get, but that's okay because<br> they are all great. <br> <br> <br> <br> I see Dr. Jeffrey Alexander in GI. He then finds a thoracic<br> surgeon. My thoracic surgeon is Dr. Francis Nichols. <br> <br> <br> <br> I first met Dr. Alexander in January 2016. <br> <br> <br> <br> I had a follow-up with him in August, and at that time he<br> said that I was now a candidate for the surgery because I<br> had lost some weight, was healthier, and they had also<br> learned that I cannot take PPIs due to genetic issues. He<br> asked if I could stay a week longer to do the testing and<br> have a subsequent follow-up with him and the surgeon because<br> I lucked out and another patient had just cancelled all of<br> these same appointments I needed. <br> <br> <br> <br> At the follow-up, I met with him again, and then he pulled a<br> thoracic surgery PA and Dr. Nichols into the room. We talked<br> everything over, and Dr. Nichols then pulled his<br> schedule/calendar up on the computer screen and we picked a<br> surgery date.<br> VIEW<br> & REPLY or reply to this email to respond.Unsubscribe<br> from this discussion thread.<br> Notification preferences can be set in your Account<br> Settings<br> <br> <br> <br>

I've heard about the wrap being too tight from one person, I think here on Connect, but I'm glad I had the surgery.

For the esophagram...
1. The radiologist stands in a small area nearby looking at a screen. There is also at least one other person with you while you are having the test. They are wearing something to protect them from the radiation.
2. They have you step up onto a platform, put your back up against it, and then drink a small amount of alka-seltzer. They watch it go down your esophagus, and they tell you to try not to burp. They then give you some barium with a straw, have you drink it, and watch it go down.
3. They then lower the table so you are laying down with your back on it. They have you drink more while laying down and watch how your esophagus works. (They hold the cup and straw for you.)
4. While you are laying down, they then have you flip over to lay on your stomach, and they have you drink more while they watch it.
5. Then, they have you turn onto your back and onto your front again. Maybe drinking some more barium.
6. After they are finished, they'll put the table upright again, and you are done.

The barium wasn't that bad and seemed thinner in consistency than I remember from years ago.
Afterward, Mayo gave me a bottle of water to drink to help get the barium out of my system. At home they didn't, but I knew to drink a lot that day from learning so at Mayo.

What size is your hiatal hernia? Mine was three-to-four centimeters. In imaging reports, radiologists act home called it small, but every Mayo radiologist called it large. (I thought that was interesting.)

The incision pains weren't bad at all and never have been. I do get small pains in my abdomen now. My PCP think it's my diaphragm. As soon as they started in early November, I emailed Mayo and they called me within 15 minutes to discuss. (

I've had excellent doctors in all of the specialties I've seen there... GI/Hepatology, Endocrine, Sleep, Nephrology, Pulmonary, Neurology, and NeuroPsychology. (Hmmm... I think that's all of them.) Doctors at Mayo don't strictly stick to 20 minutes and then kick you out the door like they do elsewhere in the country. They spend as long as you need with them. I've even had Mayo doctors chat with me and walk me to the elevator, and I've had Mayo doctors hug me after giving me good news. These are truly nice people.

As part of the pre-surgery testing, they will most likely have you do a manometry and then an esophagram if they want to further-test your esophagus after the manometry. You will need to go off of any PPI and H2 Antagonist medications, and then they will most likely want you to have an endoscopy (I think). They are checking to see what level of esophageal burn you will have from the hernia and not taking the medications. I've had them all performed there, and I've also had a colonoscopy there. Instead of prescription stuff for the prep, there is a prep that I do that uses Dulcolax and Miralax. You can google it and then ask your doctor before the colonoscopy if they feel this is a viable alternative. It's much more tolerable when it comes to having to taste it.

Many surgeons won't perform many types of surgeries if people are heavy because the weight can negatively-affect the outcome. In January 2016, I weighed in at Mayo at 198 pounds. After they figured out that I don't properly-metabolize certain medications later in the year, I was weaned off of them, and I lost ~50 pounds by the time I went back to Mayo in August.

I cannot even tell you how glad I am that I had this surgery. I wish I had done it years sooner!

Yes I had that test, it wasn't too bad. I have no idea the size of the hernia, my gastroenterologist never told me
and I never thought to ask. Did they tell y ou why you're getting small pains in your abdomen and what is it from, will they
go away.

Well I have a lot of thinking to do, my weight is a little more than yours was, over 200, what I should do is make an appointment
to visit these doctors and then they can tell me how much weight I have to lose before they can operate. Another thing does your
medical insurance pay for most of the care before and after surgery. Again you've been such a big help to me and I truly appreciate
all the detailed information you gave me.

They don't know why I have the pains. With that said, it's definitely getting better with time. It doesn't worry me at all, and it doesn't prevent me from normal activities.

You never know regarding the weight... you and I are different heights and have different circumstance, so they may be willing to perform surgery. Never know until you ask.

Interestingly, I literally just spoke with Medicare today regarding insurance, and I also obtained some Medicare/Mayo payment info from Facebook last week when I saw that someone else asked about Medicare and Mayo answered them.

I have two insurances. I have Medicare Part A as my primary for in-patient hospitalization, and my secondary insurance is via my husband's employment. Mayo is billing my in-patient, hospital stuff from October to Medicare Part A first. Anything not covered will then be billed to my secondary insurance, which Mayo has always accepted despite that I live in Western New York. The Medicare Part A deductible for 2016, when I had the surgery, was $1,288, so I will owe that amount to Mayo. (The Medicare Part A deductible for 2017 is $1,316.)

Based on your age, I assume that you have Medicare Part A, which would be used toward the surgery & hospitalization; Mayo would submit your claims and Medicare will reimburse them directly. With that said, you should be aware that Mayo is a non-participating provider under Medicare Part B, which is used to cover out-patient visits, etc. This means that Mayo sees Medicare Part B patients, but they do not always accept assignment for payment. When this happens, per Medicare, Mayo submits the claims for Part B claims to Medicare, then Medicare pays you, and you would be responsible for reimbursing Mayo.

Some info: http://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/accepted-insurance/medicare

See above for some answers to these questions. And you are very welcome!