Nissen fundoplication success

Posted by aliceorangebike @aliceorangebike, Nov 5, 2019

I’ve read a number of posts from people who are unhappy with the results of their Nissen fundoplication surgeries. I am considering having the surgery and would like to hear from people who are happy with their surgical outcomes. A recent New England Journal of Medicine article reported that two thirds of people are very satisfied with their Nissen outcomes. Do any of these people participate in these posts?

Liked by pdilly

Two thirds are satisfied? That means the chances are one out of three that you will be dissatisfied. I sure don’t like those odds.

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Hello @aliceorangebike ! I’m glad you asked. I’ve had 2 Nissen fundiplication procedures and have been very happy with both. I have Barrett’s esophagus and will be on prevacid for the rest of my life. But the Nissen pretty much eliminated my reflux without any adverse effects.

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Why did you need a second Nissan fundoplication?

Liked by pdilly

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Again, glad you asked! It’s kind of a long story.

My first Nissen was done about 5 years ago. I had been hospitalized and had lots of tests to determine why I suddenly was running a high fever for several days. (Turned out to be something non-Gastro.) But 1 of the tests showed that about 1/3 of my stomach was up in my esophagus — a huge hiatel hernia! So I had the Nissen to repair it. It greatly reduced my reflux.

Then about a year ago I started having these bouts of sudden severe stomach cramps 2 or 3 times a month. I would rush to the bathroom where I would have an explosive BM while retching violently trying to throw up at the same time!!! It was horrible!

Then this last July I had my 4th radio frequency ablation for low grade dysplasia on my Barrett’s esophagus. Afterward the surgeon told me my Nissen had come completely undone and that I would need to have another Nissen Fundiplication before he could do the next ablation.

When I had the appointment with my Nissen surgeon he was surprised that the first one had come undone. I told him it probably had something to do with the violent retching. (Seriously. It felt like my stomach was flipping over.) He asked me all about when that started and to describe the symptoms. And then he asked if I still had my gallbladder and I said yes. So he asked if I’d be willing to do some tests for my gallbladder. Said if there were any problems, he could remove the gallbladder laparoscopically when he did the Nissen.

Ultrasound was done first. No stones. Then a gallbladder function test was done. The results from that showed it was functioning at 92%. Greater than 35% is considered normal — until you get above 80%. At 92% he said my gallbladder was considered hyperactive and he recommended removal. I got a second opinion from a doc who agreed — in fact, he told me he had never seen a gallbladder functioning as high as 92% before!

So in late september I had the Nissen and gallbladder removal at the same time. Again my reflux has been almost eliminated — and without the gallbladder I haven’t had any sudden severe cramps with the explosive stuff and retching and vomiting all at the same time. I’m very pleased with a successful surgery outcome.

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Glad to hear you have it all under control now!

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PDilly,
Did you have all the procedures done at Mayo?

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@riflemanz64 No, none of my procedures were done at Mayo. I’m very fortunate to have very good docs and surgeons right here where I live.

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Had first Nissen ( note first) and the doc said to be careful with what I ate–no bread, rice, etc as it might get stuck and need follow-up surgery; asked him about vomiting–how do I do that- he said, well you can't; I said- really? Yup! Watched everything I ate, and if I even thought for a moment the food was bad, did not eat it–wanted to take no chances with vomiting. But 7 years later, had violent vomiting episode and the Nissen "popped"- I could feel it give way; the pressure stopped, but the GERD returned. Second Nissen performed by same physician- said he had not heard of anyone needing a second. All the same precautions taken. Second one failed 5 years later– "slipped" –same feeling as before. Went to surgeon of some local fame and he said a third one would result in about a 25% success rate. Also said that my problem sound more like an emptying problem- tested and yes the emptying was very, very slow! Recommendations:
1. implant pacemaker type device to stimulate the lower muscle to allow for better emptying; or 2. subtotal gastrectomy with roun-y– ie, remove most of the stomach, and attach small pouch of stomach (tangerine sized) to small intestine; First option would last about a year, and most people came back for the gastrectomy. I opted for the one time fix- no stomach caused many other issues- intestinal gas was beyond description- found OTC chewable 3x day, and that helps– but if I miss one dose, I have to be away from people. I carry a bottle with me at all times. Had some loose stool issues that became a little more prevalent. Still was not getting better–final straw- colonoscopy revealed tumor; most colon removed. No further spread, so far, but subsequent colonoscopies have been horrendous- not the prep– the poor prep and being accused of failing to follow directions- after 3 colonoscopies, finally had a doc give me a tentative OK- prep still not good, but enough to say you are probably OK….nice….
So now have major diarrhea all the time- 2 hour max limit between toilet sessions- even at night! No one can give me any insight into how to fix- been to Mayo and am very disappointed with lack of outcomes–not sure who to go to, if anyone….
Be vigilant; be your own advocate; do not take the docs word as gospel–ask questions until you get your answer…not theirs; that part I am still working on…
best to all, Bill

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@azcyclist2018

Had first Nissen ( note first) and the doc said to be careful with what I ate–no bread, rice, etc as it might get stuck and need follow-up surgery; asked him about vomiting–how do I do that- he said, well you can't; I said- really? Yup! Watched everything I ate, and if I even thought for a moment the food was bad, did not eat it–wanted to take no chances with vomiting. But 7 years later, had violent vomiting episode and the Nissen "popped"- I could feel it give way; the pressure stopped, but the GERD returned. Second Nissen performed by same physician- said he had not heard of anyone needing a second. All the same precautions taken. Second one failed 5 years later– "slipped" –same feeling as before. Went to surgeon of some local fame and he said a third one would result in about a 25% success rate. Also said that my problem sound more like an emptying problem- tested and yes the emptying was very, very slow! Recommendations:
1. implant pacemaker type device to stimulate the lower muscle to allow for better emptying; or 2. subtotal gastrectomy with roun-y– ie, remove most of the stomach, and attach small pouch of stomach (tangerine sized) to small intestine; First option would last about a year, and most people came back for the gastrectomy. I opted for the one time fix- no stomach caused many other issues- intestinal gas was beyond description- found OTC chewable 3x day, and that helps– but if I miss one dose, I have to be away from people. I carry a bottle with me at all times. Had some loose stool issues that became a little more prevalent. Still was not getting better–final straw- colonoscopy revealed tumor; most colon removed. No further spread, so far, but subsequent colonoscopies have been horrendous- not the prep– the poor prep and being accused of failing to follow directions- after 3 colonoscopies, finally had a doc give me a tentative OK- prep still not good, but enough to say you are probably OK….nice….
So now have major diarrhea all the time- 2 hour max limit between toilet sessions- even at night! No one can give me any insight into how to fix- been to Mayo and am very disappointed with lack of outcomes–not sure who to go to, if anyone….
Be vigilant; be your own advocate; do not take the docs word as gospel–ask questions until you get your answer…not theirs; that part I am still working on…
best to all, Bill

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Wow, So sorry to hear this . I hope you find relief. I had my first Nissen and hernia surgery back in April of this year and having non stop issues ! My regular doc thinks dumping syndrome ? Going back to see my surgeon again for 3rd time to see once again for another follow up ! Not at all happy with the outcome !

Liked by pdilly

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Yes dumping syndrome is a big deal–did you hear about that as part of your surgery pre or post work? I was told that I could have a very limited amount of food at any one time. Usually about 1/2 to 1 cup of food/liquid— I found out very quickly that limit was very accurate. You can eat slower and spread out the time you eat, but be really careful about overloading – it is miserable. "Dumping" will happen one of two ways, from my experience: vomiting or diarrhea. I have "perfected" my eating to a point where I will literally stop eating with one bite left; and will only eat half of any meal out–get the doggie bag and put half in it before you start. Short of the vomiting, I have found that if on the edge of a dumping episode, I will go lay down and that relieves some of the pressure-does not work every time, but it has helped with some cases. Best scenario: do not ever "over-eat". Although several years since my surgeries, I still get caught with a bad eating episode; just this past week I ate, literally!, one too many tortilla chips- I could feel go all the way down, and it felt like it lodged against something, and was poking my gut; sorry if too graphic. Became nauseated, congested, gut pain…for one chip!!??!!
Live and learn– best to learn early as there is no going back.
best to you, faithann64
bill

Liked by pdilly

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@azcyclist2018

Yes dumping syndrome is a big deal–did you hear about that as part of your surgery pre or post work? I was told that I could have a very limited amount of food at any one time. Usually about 1/2 to 1 cup of food/liquid— I found out very quickly that limit was very accurate. You can eat slower and spread out the time you eat, but be really careful about overloading – it is miserable. "Dumping" will happen one of two ways, from my experience: vomiting or diarrhea. I have "perfected" my eating to a point where I will literally stop eating with one bite left; and will only eat half of any meal out–get the doggie bag and put half in it before you start. Short of the vomiting, I have found that if on the edge of a dumping episode, I will go lay down and that relieves some of the pressure-does not work every time, but it has helped with some cases. Best scenario: do not ever "over-eat". Although several years since my surgeries, I still get caught with a bad eating episode; just this past week I ate, literally!, one too many tortilla chips- I could feel go all the way down, and it felt like it lodged against something, and was poking my gut; sorry if too graphic. Became nauseated, congested, gut pain…for one chip!!??!!
Live and learn– best to learn early as there is no going back.
best to you, faithann64
bill

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Never was told about dumping syndrome ! It's totally ridiculous what I've been going through the last 6 months. At surgery ( April 15th ) I was 243 pnds. I'm male, 5-11. Now at 193 pnds. Can't hardly eat anything, even liquids not comfortable going down . My primary has me back on liquid diet . I'm in constant stomach pain, sometimes the cramping is unbearable. Nausea, bloating, explosive diarrhea, hot flashes, heart palpitations, loud rumbling stomach, not possible to vomit after nissen fundoplication and hiatal hernia surgery. When I do eat I hafta stay close to bathroom, pretty much runs straight through me. It's affected every part of my life ! I see surgeon in couple days , looking like I'll probably be getting 2nd opinion !

Liked by pdilly

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I agree that the pre op information about complexities is sometime lacking–same for me, and my GI doc and surgeon were really good–but still did not/could prep me for the journey post op. I really had t change eating patterns radically– the "no bread/no rice" thing was an insight, but would have been better to have some genuine nutrition counseling so I would have been better prepared–and not the "eat less carbs, eat more protein" garbage that I heard. I also am 5'11'" and at initial surgery weighed 199- lost 45 pounds after; did the nutrition drinks quite a lot, and was very slow at eating solids. No carbonated drinks then, now, and ever. Not being able to vomit was a worry, but not being able to burp??!!! That was painful! Did not drink a good deal before, but as of then, no carbonation.The gut sounds, cramps, gas/boating, all the same- was told that when the gut is operated on, it takes a long time to get back to better routine…wont say normal as that word is unhelpful. Hope yours was done via laparoscopic- even with this, the gut is still jumbled around a lot- as I heard a nurse tell me–you have just experienced planned trauma! Still trauma… keep asking questions; This site has been helpful in terms of info sharing; experiences of others helps with the perspective.
take care

Liked by pdilly, faithann64

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I associate with every single one of you. I had the Nissen in 2013 AND 2 years later the Toupet fundoplication. 195 lbs. then, 105 lbs. now. I have violent dumping syndrome issues STILL. I fear getting the stomach flu… as I cannot throw up. Will I drown? The wretching during dumping is horrid… the pain makes you moan and hollar out with the pain that runs from under your ribs to your pelvic bone. Once its out of me, I am fine again. Sometimes it IS that one more bite that does it… sometimes its only just a half cup of food. I have dyphagia, 5 nodules on thyroid that they have told me not to worry about. Plus I am filled with adhesions. I have limited movement due to the pulling. Lots of positional pain, stinging. Previous adhesions were attached to my ribs and bottom of my heart. I am pretty sure the adhesions are back. I lost my gall bladder way before the Nissen, plus in 2000 I had a 5 lb messenteric abdonimal cyst removed and Marlex mesh implanted for incisional hernias. I have had 6 abdominal surgeries. Dont trust any of the doctors anymore. The fix is temporary. I am so skinny and weak, have lost all muscle mass. I am a saggy (excess skin) bag of bones. Have been accused of being a meth head or anorexic. I hate what has been done to me. Please get second opinions… or thirds!! Nissen and toupet fundoplications fail more than succeed. I am forced now to just live with it. I quit my lifelong job to recover, lost my health insurance before I knew I actually wasnt fixed. I feel cheated and stupid. My first nissen surgeon was a general surgeon, the second was a weight loss surgeon. PLEASE go to a gastric specialist!! Now I just try to survive by barely eating… to try and maintain this weight and avoid dumping. Its not healthy, I don't recommend it. I hate this! I am a 58 year old female. I am sorry this has happened to us… but it helps to know I am not alone. Thanks for sharing your stories.

Liked by pdilly, faithann64

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@sickvick

I associate with every single one of you. I had the Nissen in 2013 AND 2 years later the Toupet fundoplication. 195 lbs. then, 105 lbs. now. I have violent dumping syndrome issues STILL. I fear getting the stomach flu… as I cannot throw up. Will I drown? The wretching during dumping is horrid… the pain makes you moan and hollar out with the pain that runs from under your ribs to your pelvic bone. Once its out of me, I am fine again. Sometimes it IS that one more bite that does it… sometimes its only just a half cup of food. I have dyphagia, 5 nodules on thyroid that they have told me not to worry about. Plus I am filled with adhesions. I have limited movement due to the pulling. Lots of positional pain, stinging. Previous adhesions were attached to my ribs and bottom of my heart. I am pretty sure the adhesions are back. I lost my gall bladder way before the Nissen, plus in 2000 I had a 5 lb messenteric abdonimal cyst removed and Marlex mesh implanted for incisional hernias. I have had 6 abdominal surgeries. Dont trust any of the doctors anymore. The fix is temporary. I am so skinny and weak, have lost all muscle mass. I am a saggy (excess skin) bag of bones. Have been accused of being a meth head or anorexic. I hate what has been done to me. Please get second opinions… or thirds!! Nissen and toupet fundoplications fail more than succeed. I am forced now to just live with it. I quit my lifelong job to recover, lost my health insurance before I knew I actually wasnt fixed. I feel cheated and stupid. My first nissen surgeon was a general surgeon, the second was a weight loss surgeon. PLEASE go to a gastric specialist!! Now I just try to survive by barely eating… to try and maintain this weight and avoid dumping. Its not healthy, I don't recommend it. I hate this! I am a 58 year old female. I am sorry this has happened to us… but it helps to know I am not alone. Thanks for sharing your stories.

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So sorry. I think people getting ready to go through this should ask and ask allot of questions ! My surgeon basically told me I really didn't have a choice anymore because of all the medical issues I was having before surgery ? I hope all of us can overcome these issues soon !

Liked by pdilly

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@faithann64

Never was told about dumping syndrome ! It's totally ridiculous what I've been going through the last 6 months. At surgery ( April 15th ) I was 243 pnds. I'm male, 5-11. Now at 193 pnds. Can't hardly eat anything, even liquids not comfortable going down . My primary has me back on liquid diet . I'm in constant stomach pain, sometimes the cramping is unbearable. Nausea, bloating, explosive diarrhea, hot flashes, heart palpitations, loud rumbling stomach, not possible to vomit after nissen fundoplication and hiatal hernia surgery. When I do eat I hafta stay close to bathroom, pretty much runs straight through me. It's affected every part of my life ! I see surgeon in couple days , looking like I'll probably be getting 2nd opinion !

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I experienced most of the same 4 years ago.. Have you been to Mayo Minnesota or similar top GI clinic..? Mayo doc told me I had Post operative Gastropaneisis..but they gave me a way to cope.. smoothies small pieces and amounts all the time. One in Six Nissens Fail was the figure Mayo told me…get a referral..perhaps the operation made it too tight…that can be mitigated..Mayo told me that mine couldn't be reversed/ undone..

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