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Second Nissen Failure... what are my options?
First, a quick summary:
I had my first Nissen 14 years ago at around age 22. It lasted maybe 6/7 years before I started having serious issues again. I spent a little over 2 years with various gastroenterologists dealing with that and eventually went to the Mayo Clinic in Minnesota for a more holistic analysis.
I eventually had the Nissen repaired (with mesh) back here in Austin, TX when I was around 30. Now, six years later, the problems are back.
I'm 6'1", 200lbs, and have a body fat percentage at around 12%, so I'm a healthy weight. I exercise and eat well. I've been on heavy PPIs for the past couple months with no beneficial results, just as before. PPIs tend to make me a bit constipated and gassy, too, which only seems to exacerbate my pains.
I had a barium swallow last week and an endoscopy two days ago. The endoscopy showed a 3cm hernia (Hill class III, apparently). I don't think that's a particularly large herniation, but it definitely feels like there's someone pinching my lower esophagus all the time, even if I'm just drinking water or sitting down.
I'm still waiting to hear back from the gastroenterologist, who seemed to really want this to have been EoE because that's his specialty and he seems to think hiatal hernias aren't that big of a deal. Honestly, it's a bit frustrating that he isn't focused on that, but I've had previous doctors who look at issues like they're still working on their graduate thesis. Fortunately, there isn't a strong indication of eosinophils in the esophagus to be suggesting that's the key issue.
What I want to know is what peoples' experience is with repairs are and, more specifically, if there are alternatives I should approach with other medical professionals. I've read some articles in medical journals that show the LINX procedure has been used on failed Nissen operations, though there is a lot of debate on the use and efficacy of it for a failed Nissen with potential scar tissue. It seems like the LINX would at least create a buttress around the esophageal sphincter that would help further prevent it from herniating over the diaphragm.
I've also read anecdotal evidence of EsophyX/TIF procedures being used for repair of a failed LNF, though they don't have the longevity that a Nissen apparently does. Given my experience with the longevity of my wraps, a less-invasive option at least sounds like it wouldn't keep compounding the issue if it needed another revision. I imagine that wouldn't fix the diaphragm opening if it's problematic, though.
I'm not sure what the mechanical failure of my wrap is (I take it it's either slipped or the entire wrap may have herniated?) so I don't know if there are different approaches depending on the specifics of that.
So... Has anyone had a LNF repaired by other means than a complete LNF redo? Are there less invasive methods of correction that are practiced? My fear is that gastro doctors will always try and medicate the issue and will be reluctant to refer to a surgeon (based on my experiences of being in limbo for a couple years in similar situations), but I'm also nervous that some surgeons will be too unfamiliar with things like TIF/LINX/EsophyX/etc to consider them when they may be a viable option.
Sorry for the long post.
Thanks, everyone!
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Hi @lesleelane and welcome to Mayo Clinic Connect. I am so sorry that you are going through this. I have to say that I have had the Roux-en-Y gastric bypass and it made my medical experience exponentially harder. It was 15 years ago and I still vomit weekly, have a terrible problem with gastric ulcers perforating and have been admitted to the hospital more times than I can count. If it were a choice for me, I would look for any alternative that was not surgery. Have they given you the GI cocktail of Maalox, lidocaine and liquid Tylenol?
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3 ReactionsI had a Nissen in Nov of 2021. The symptoms actually got worse after the procedure. I had a redo in Feb of 2023. The redo took between 6 and 7 hours. My stomach was basically wrapped around my stomach and it took 2 hours just to eliminate the adhesions. It was a mess. I also had a pylorplasty at the same time due to gastroparisis, which I think happened from the initial nissen procedure.
In fact, my entire gastrointestinal system is non-functioning. I have intestinal motility issues as well and take large amounts of laxatives daily. It’s like neuropathy of my entire gastrointestinal system.
The nissen redo worked great for 6 months. Then about 2 weeks ago, I started feeling some burning in my throat and below my sternum. Not as severe as before, but there. I had a repeat endoscopy yesterday and unfortunately the nissen has slipped and my esophagus is inflamed and in worse condition than a year ago; now grade D (was grade B last year). The gastroenterologist says my options are more limited now - possibly a gastric bypass. This is scary to me. I am 60 yo and weigh 130lbs. Has this happened to anyone else? What are my options?
Hi @terrijwright. I moved your discussion and combined it with an existing discussion titled:
- Second Nissen Failure.. what are my options?
https://connect.mayoclinic.org/discussion/second-nissen-failure-what-are-my-options
I did this so you could meet members like @sisypheanpatient, @sickvick, and @ken82 who have discussed their Nissen failures. You can read their experiences in the new location.
@terrijwright - this all must be very frustrating. Were you given an explanation on why the nissen slipped so quickly this second go around?
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2 ReactionsHello,
I have also experienced 2 Nissen failures. The first went at 1.5 years, and the second after only 8 hours while still in the hospital recovering from the procedure. It was a chain of events that could not have been predicted, and one for the books! I'll address that "nightmare" in a separate post.
Sounds like you need a conference call with some of the top minds who do their best work when challenged. And yours fits the bill.
Gather all your relevant medical records, include a one page bio, and submit to chiefs, dept. of gastroenterology at Stanford (Palo Alto), UCSF Medical Center (San Francisco), Johns Hopkins...and so on. Concentrate on teaching institutions because that's where innovative medicine tends to originate.
Anyway, there's a solution out there, so keep moving forward.
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1 ReactionI believe the first nissen I had also caused my gastroparisis.
I began having nausea and retching immediately following the procedure. The nissen ended up not just slipping, but falling. My surgeon who repaired it and did the second nissen basically said it was a mess. He questioned if the original surgeon did what he was suppose to do. I’m sorry about your gastroparisis. It is just an horrible issue to deal with, on top of the GERD issue.
After my 2nd failed Lap-Nissen, I contacted the LINX people about use-history of their product after failed Nissens and they were very reluctant to address the subject.
This prompted me to think about how their system has to interact with the anatomy. I concluded that regardless of where the Linx device is placed, that each time someone swallows, the esophagus will rub against the LINX inner ring, becoming abraded in the process. This must undoubtedly lead to further complications, though how quickly would depend on many variables. I base my conclusions on nothing more than common sense, and am by no means an expert in bio-mechanics or biomedical engineering.
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