Reversal of Nissen Fundoplication

I had a revision of my 360 last year... toupet this time. Still having bad reflux, choking/coughing at night (sleep study negative for apnea). Surgeon wants to do a partial gastrectomy w/ a Roux-en-y. He said the last surgeon should not have done a Nissen revision and should have done a bypass instead because I had dysmotility of my esophagus so wrapping it again would exacerbate the reflux, which it did. Insurance will pay for the bypass, but they won’t pay for the takedown bc there’s no CPT other than unlisted which they consider “experimental.” Can’t do a bypass until the wrap comes down. Even though my deductible is met I am still having to “cough up” $5,000 up front to pay for the takedown. Is there any way to get insurance to see that this is medically necessary and that the wrap is making my symptoms worse? How come the takedown was paid for in the revision?

why did you have to have your 360 revised? what were all your symptoms/ i had a 360 done 2.5 years ago and it has been bad for m e since. i have had no reflux, as proven by all the testing. i have weakened esophagus muscles due to probably my Rheumatoid arthritis. after the last barium swallow i could see that water hangs up above the wrap since it is so tight. the surgeon wants me to have an egg swallow test (with a radioactive tracer) to see how long the food stays in my stomach . if it is too long, which can cause esophagus irritation then surgeon will inject botox into the outlet of the stomach (pyloric sphincter) to allow the emptying to be quicker. be very careful of the bypass. i know of a friend who has had this and she has many more problems. when you did your last esophagael manometry what was your "distal contraction integral" value? it should be between 500-5000. if yours was less than 500 (mine is 398.3) then you may have an "hypersensitive esophagus" as i have. prior to fundoplication it was 517.3 ( just above the minimum)....if there were any promotility drugs availiable then your symptoms mayhave been not so severe. your sutgeon needs to recode this as mandatory surgery.... good luck and god bless....kozlo52

My 360 slipped and I had a paraesophageal hiatal hernia. My esophagus was completely compressed...I couldn’t even swallow water. The surgeon that did it even noted several times that there was diminished motility. The wrap should have come down and stayed down instead of wrapping it again. The wrap further increased the pressure gradient in my esophagus. My vagus nerve was also damaged which caused gastroparesis evidenced by a gastric emptying study. Gastric bypass is an approved surgical treatment for GERD (as well as paresis) in patients whose Nissens have failed. It just makes no sense to me that insurance agrees that the bypass is medically necessary in this case, but won’t pay to reverse the wrap that’s exacerbating my symptoms. Can’t do the medically necessary bypass until wrap is taken down.

My Nissen was done in Iowa, they couldn't figure out what went wrong but MayoGI figured it out in a morning of tests. They said my Nissen could not be taken down or reversed.. it would be worse than before.. I t was explained to me that some of the hair net like nerves that cause the stomach to empty were damaged and I would depend on gravity and time... learning to cope has been a long process. Every meal or time I eat is a challenge..

what are your symptoms when eating? heartburn, mouth burn. throat burn? i 'd be interested in hearing your experience...thanks... kozlo52

I cannot eat very much at a time. Sometimes food seems to be caught for a little while. It takes an hour or more in any meal . Grazing works best that is, for example: in the morning take my pills, have coffee...in 20 minutes have a banana, while eating on that over 15 minutes...make some raisan toast with real butter, more coffee, while making oatmeal.. do 1 slice of bacon..cut in half prior to microwave...this process while doing a crossword often lasted 90 minutes...I am retired. When food is caught and that foam starts, it is best to let it come up...then start again in 20 minutes...when I eat that slow I rarely have trouble.. orange juice take only a little at a time...I try to have some citrus every day to combat kidney stones... Trail mix is great...cheese and crackers work for me...no carbonated beverages..unless it is flat over a lot of ice and vodka...or whatever..

I don't have any of those burning sensations

I am a 26 year old female who has had a Nissen Fundoplication and Hiatal Hernia repair done August 16th, 2018.

Backstory/history of reflux symptoms: Prior to the surgery I was having burning in the throat that didn't correlate to what I ate, my incline position while sleeping, or any activities. It felt like I had hot sauce in my throat almost 24/7. This started March-May of 2018. While it was happening, my GI prescribed many different types of anti-acids. The only one that seemed to work was Dexilant. Eventually, I got Cdiff from all these anti-acids. I stopped taking it in May. Ironically, my throat burning went away shortly after. I was tired of taking medicine and didn't want to get Cdiff again so I asked my dr to refer me to a surgeon.

I had a reprieve from the throat burning from mid May-early August. A week before my surgery I started getting a tiny amount of throat burning only after waking up from sleeping. It wasnt happening 24/7 anymore. I decided to go through with the surgery as aided by the advice of my GI surgeon. My 24hr impedance monitor/manometry showed that I did not have any acid coming up, but the surgeon said I still could be refluxing hence the hypersensitivity. I went through with the procedure still as I thought It would make my life better.

Upon waking in recovery, that familiar feeling of hot sauce in my throat came back. The surgeon assured me it was only from the breathing apparatus during the surgery. He also said he found a larger than usual hiatal hernia for someone my age. (This is my theory as to why my throat was burning initially). Within a week after surgery, I regretted having the procedure done. I felt like my issues were more neurological and I should not have been advised surgery. I went to Georgetown Hospital in December 2018 to see if a surgeon there would undo the wrap. He said there was a possibility but I had to re-do all my tests again. Because of the unexplained burning, he wanted to make sure after 4 months that my wrap was still in tact. I had an upper gi, another manometry, 24hr esophageal test, and gastric emptying. The demeester score was lower with the wrap than before yet my throat burning symptoms were more intense. The manometry tube and ph monitor with the wrap caused me to gag profusely. Since the manometry after the wrap, I have had issues with hypersalivation. I constantly am spitting or swallowing, the swallowing causes so much distention that my stomach is bigger after surgery despite having lost 35+ pounds. The gagging during the visit triggered something in regards to my vagal nerve. I have tried Amitriptyline to dry my mouth and calm my nerves and Gabapentin. Both cause my tinnitus to increase and does not do much for the excess drooling. The surgeon at Georgetown did not want to undo my wrap after all my tests came back normal.

Since last week, my chest above my diaphragm where the hiatal hernia was fixed has started to hurt in a similar way to what my post op felt like (lots of dull chest pain followed by tachycardia). In addition, I now have strange gurgling sounds in my stomach after I eat or drink with the lack of ability to pass much gas despite taking Gas-X Extra Strength. I feel like my wrap might have slipped? For the past week I have also been feeling like I've had no appetite. I was 150lbs before the procedure and now I am 110 and still loosing weight as of this last week following the recent chest pains and lack of apetite. Since the hypersalivation, I've been swallowing so much air that gassing through the day is the only way to get relief. Now I am not able to do so.

To sum this all up, I wanted to know if anyone had advice in regards to finding someone who would help augment this procedure? Maybe loosen it up or put the Linx device in instead? Basically, I had a procedure that caused burning In my throat only to have more tests done which caused gagging and then hypersalivation...which then lead to swallowing more air and being so distended that I end up looking many months pregnant. I am living in constant pain, I rarely sleep. The surgery has changed my life. The only thing that keeps me going is the hope this can be undone. I am thinking I was hypersensitive and stressed out before, and then having this surgery has caused some sort of vagal nerve sensitivity. Any advice, thoughts, or comments would be appreciated. I've been hesitant on researching drs and re-hashing my story, it causes a lot of stress.

I’m going through the same misery, although your post is old I’m hoping you have gotten better since .

Has anyone ACTUALLY gotten it and can tell us about it? Everything I have searched for on here is people just considering it but I have not seen one person talk about getting it done and what the results were.

I'm 33 years old, I was 31 when I got diagnosed with a hiatal hernia. I was the picture of health, everyone guessed that I was 20 years old. Out of nowhere, I had acid reflux built up to my vocal cords because of the hernia and it took them 4 months to figure it out. The surgeon convinced me to do a Laparoscopic Nissen Fundoplication, described it as "you'll only be out for 3 days and you'll be eating completely normal in 3 weeks." Sounded like a piece of cake, right?

After 3 weeks, I still couldn't eat anything besides Ensure and Jello, then I researched it and it was more typical that eating struggles were to continue 3-6 months in reality. After 6 months, I really started to panic. Long story short, it's been 2 and a half years since my surgery, and every day I am spitting up something if I attempt to eat it. It gets stuck in my throat. I have phlegm 247 no matter what I do.

I am at the point where I have had every single test done that I can, and the GI is telling me the only thing left to do is reverse it. I am worried about the risk. In trying to research it on my own, I can't even find anyone that has done a reversal to see what I can expect. I cannot live the rest of my life drinking smoothies for every meal.

Aside from wanting my health to improve, I am also wondering about suing the surgeon who make it sound like a no-brainer piece of a cake when I never would have done this surgery if I knew I literally wouldn't be able to eat normally again FOREVER.

Please, if you have had a reversal of a Laparoscopic Nissen Fundoplication, tell us your results.

PLEASE