Reversal of a fundoplication

Hello, I'm new to this group, but I can see that there is a lot of experience here. There are a lot of unhappy experiences out there and I might say that I'm one of them, but I naturally want to avoid making it worst. I've got a very unique situation and have encountered a variety of problems in getting diagnosed and establishing a path back to health. Since this group is focused on GI, I will also, but my issues actually involve neural and vascular as well. I'll try to be as specific as possible, but I must apologize for such a long narration. It may not be obvious, but this is a highly condensed version of the issues that I have to navigate.

I have been motivated by an periodic abdominal just to the right of the solar plexus. It can wax and wane over months. It can also be a mild nusance or drop me to my knees gasping for breath. My gallbladder was deficient and was removed 2 years ago in the hope of relief, it did not help.

I had a nissen & highly selective vagotomy about 15 years ago. It was successful up to a couple of years ago and it has now "slipped" and appears to be hanging on the esophagus below an enlarged hiatal hernia. I've recently underwent the gastric emptying test that showed a delayed action on the first hour. i.e. gastroparesis. If this is a complication from the Nissen, I don't know, but in my opinion a pyloroplasty will most likely make things worst. That leaves my main question. My options are 1) do nothing 2) Nissen redo 3) Nissen unwrap. I'm tempted to go with the unwrap, but I would like to find out what to expect.

Working out from that issue, right next door, just a inch or two away, I have a celiac stenosis, which fits the classical pattern for MALs (Median Arcuate Ligament syndrome). This can inhibit blood flow to the digestive system. Unfortunately, completely unrelated to me, there is an academic dispute regarding the legitimacy of the syndrome. It turns out that Stanford, where I have been evaluated, does not consider this to be valid condition. If being caught up in this argument wasn't frustrating enough, their vascular surgeons have completely invalidated their "objectivity" on a unrelated matter.

About 10 years ago, I came down with a idiopathic peripheral neuropathy with a devastating fatigue. To control the pain, I've been seeing a pain specialist that has kept me on a moderate dose of methadone. At my first appointment with Stanford's vascular department, they immediately classified me as a drug abuser and things went downhill from there. They concluded that methadone is only used for heroin addiction and could not understand why I was taking it since I never even tried heroin. That physician offered no help in any form, no testing, no useful referrals, and then wrote a false narrative that included some actual facts, but altered the context and sequence of events. Just to be sure, he phrased it to make me sound like the classical abuser, not an actual patient. In short, he did everything in his power to keep me from decent medical care.

Obviously, I'm still angry about this. Especially since that report has played out in following visits where I was subjected to very abusive treatment from the very doctors that are suppose to help. However, I persisted and finally got a bit of my message out, but even so, the bariatric surgeon that I'm presently talking too can only offer an opinion on the digestive side of my case. Obviously, however, the digestive tract cannot function properly without an adequate flow of blood. The laparoscopic entry is identical for both the Nissen and MALs. I've already had my gallbladder out in an attempt to alieviate the abdominal pain, so I don't want to break this out into multiple surgeries. But, then Stanford does not subscribe to the MALs diagnosis and apparently doesn't consider a celiac stenosis to be a serious condition because it is "widely patent", meaning other vessels feed the organs. Except I've had GI troubles for over 35 years, at any rate, though, Stanford's vascular department has lost all credibility for me. Which means my surgeon can only focus on half of my issue and leaves me in a position of having to go "shopping" for a diagnosis. It is a dilemma.

All this leaves me with a great deal of uncertainty as to how to find help. That is why I am considering to just have the Nissen unwrapped and learn to deal with the reflux. I already have the Barrett's esophagus anyhow, which is what the original surgery was intended to prevent.

Well, thanks to anyone that can provide some insight into these problems. Hope to hear from you all soon.

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Hello, I'm new to this group, but I can see that there is a lot of experience here. There are a lot of unhappy experiences out there and I might say that I'm one of them, but I naturally want to avoid making it worst. I've got a very unique situation and have encountered a variety of problems in getting diagnosed and establishing a path back to health. Since this group is focused on GI, I will also, but my issues actually involve neural and vascular as well. I'll try to be as specific as possible, but I must apologize for such a long narration. It may not be obvious, but this is a highly condensed version of the issues that I have to navigate.

I have been motivated by an periodic abdominal just to the right of the solar plexus. It can wax and wane over months. It can also be a mild nusance or drop me to my knees gasping for breath. My gallbladder was deficient and was removed 2 years ago in the hope of relief, it did not help.

I had a nissen & highly selective vagotomy about 15 years ago. It was successful up to a couple of years ago and it has now "slipped" and appears to be hanging on the esophagus below an enlarged hiatal hernia. I've recently underwent the gastric emptying test that showed a delayed action on the first hour. i.e. gastroparesis. If this is a complication from the Nissen, I don't know, but in my opinion a pyloroplasty will most likely make things worst. That leaves my main question. My options are 1) do nothing 2) Nissen redo 3) Nissen unwrap. I'm tempted to go with the unwrap, but I would like to find out what to expect.

Working out from that issue, right next door, just a inch or two away, I have a celiac stenosis, which fits the classical pattern for MALs (Median Arcuate Ligament syndrome). This can inhibit blood flow to the digestive system. Unfortunately, completely unrelated to me, there is an academic dispute regarding the legitimacy of the syndrome. It turns out that Stanford, where I have been evaluated, does not consider this to be valid condition. If being caught up in this argument wasn't frustrating enough, their vascular surgeons have completely invalidated their "objectivity" on a unrelated matter.

About 10 years ago, I came down with a idiopathic peripheral neuropathy with a devastating fatigue. To control the pain, I've been seeing a pain specialist that has kept me on a moderate dose of methadone. At my first appointment with Stanford's vascular department, they immediately classified me as a drug abuser and things went downhill from there. They concluded that methadone is only used for heroin addiction and could not understand why I was taking it since I never even tried heroin. That physician offered no help in any form, no testing, no useful referrals, and then wrote a false narrative that included some actual facts, but altered the context and sequence of events. Just to be sure, he phrased it to make me sound like the classical abuser, not an actual patient. In short, he did everything in his power to keep me from decent medical care.

Obviously, I'm still angry about this. Especially since that report has played out in following visits where I was subjected to very abusive treatment from the very doctors that are suppose to help. However, I persisted and finally got a bit of my message out, but even so, the bariatric surgeon that I'm presently talking too can only offer an opinion on the digestive side of my case. Obviously, however, the digestive tract cannot function properly without an adequate flow of blood. The laparoscopic entry is identical for both the Nissen and MALs. I've already had my gallbladder out in an attempt to alieviate the abdominal pain, so I don't want to break this out into multiple surgeries. But, then Stanford does not subscribe to the MALs diagnosis and apparently doesn't consider a celiac stenosis to be a serious condition because it is "widely patent", meaning other vessels feed the organs. Except I've had GI troubles for over 35 years, at any rate, though, Stanford's vascular department has lost all credibility for me. Which means my surgeon can only focus on half of my issue and leaves me in a position of having to go "shopping" for a diagnosis. It is a dilemma.

All this leaves me with a great deal of uncertainty as to how to find help. That is why I am considering to just have the Nissen unwrapped and learn to deal with the reflux. I already have the Barrett's esophagus anyhow, which is what the original surgery was intended to prevent.

Well, thanks to anyone that can provide some insight into these problems. Hope to hear from you all soon.

Jump to this post

Hello, I'm new to this group, but I can see that there is a lot of experience here. There are a lot of unhappy experiences out there and I might say that I'm one of them, but I naturally want to avoid making it worst. I've got a very unique situation and have encountered a variety of problems in getting diagnosed and establishing a path back to health. Since this group is focused on GI, I will also, but my issues actually involve neural and vascular as well. I'll try to be as specific as possible, but I must apologize for such a long narration. It may not be obvious, but this is a highly condensed version of the issues that I have to navigate.

I have been motivated by an periodic abdominal just to the right of the solar plexus. It can wax and wane over months. It can also be a mild nusance or drop me to my knees gasping for breath. My gallbladder was deficient and was removed 2 years ago in the hope of relief, it did not help.

I had a nissen & highly selective vagotomy about 15 years ago. It was successful up to a couple of years ago and it has now "slipped" and appears to be hanging on the esophagus below an enlarged hiatal hernia. I've recently underwent the gastric emptying test that showed a delayed action on the first hour. i.e. gastroparesis. If this is a complication from the Nissen, I don't know, but in my opinion a pyloroplasty will most likely make things worst. That leaves my main question. My options are 1) do nothing 2) Nissen redo 3) Nissen unwrap. I'm tempted to go with the unwrap, but I would like to find out what to expect.

Working out from that issue, right next door, just a inch or two away, I have a celiac stenosis, which fits the classical pattern for MALs (Median Arcuate Ligament syndrome). This can inhibit blood flow to the digestive system. Unfortunately, completely unrelated to me, there is an academic dispute regarding the legitimacy of the syndrome. It turns out that Stanford, where I have been evaluated, does not consider this to be valid condition. If being caught up in this argument wasn't frustrating enough, their vascular surgeons have completely invalidated their "objectivity" on a unrelated matter.

About 10 years ago, I came down with a idiopathic peripheral neuropathy with a devastating fatigue. To control the pain, I've been seeing a pain specialist that has kept me on a moderate dose of methadone. At my first appointment with Stanford's vascular department, they immediately classified me as a drug abuser and things went downhill from there. They concluded that methadone is only used for heroin addiction and could not understand why I was taking it since I never even tried heroin. That physician offered no help in any form, no testing, no useful referrals, and then wrote a false narrative that included some actual facts, but altered the context and sequence of events. Just to be sure, he phrased it to make me sound like the classical abuser, not an actual patient. In short, he did everything in his power to keep me from decent medical care.

Obviously, I'm still angry about this. Especially since that report has played out in following visits where I was subjected to very abusive treatment from the very doctors that are suppose to help. However, I persisted and finally got a bit of my message out, but even so, the bariatric surgeon that I'm presently talking too can only offer an opinion on the digestive side of my case. Obviously, however, the digestive tract cannot function properly without an adequate flow of blood. The laparoscopic entry is identical for both the Nissen and MALs. I've already had my gallbladder out in an attempt to alieviate the abdominal pain, so I don't want to break this out into multiple surgeries. But, then Stanford does not subscribe to the MALs diagnosis and apparently doesn't consider a celiac stenosis to be a serious condition because it is "widely patent", meaning other vessels feed the organs. Except I've had GI troubles for over 35 years, at any rate, though, Stanford's vascular department has lost all credibility for me. Which means my surgeon can only focus on half of my issue and leaves me in a position of having to go "shopping" for a diagnosis. It is a dilemma.

All this leaves me with a great deal of uncertainty as to how to find help. That is why I am considering to just have the Nissen unwrapped and learn to deal with the reflux. I already have the Barrett's esophagus anyhow, which is what the original surgery was intended to prevent.

Well, thanks to anyone that can provide some insight into these problems. Hope to hear from you all soon.

Jump to this post

Hi,Debbie here.I just had my nissian Fundplication wrap redone on July 6,2017.I have been telling my surgeon and Gi doctor for 3 1/2 years it was too tight and ablot of issues .Well finally went in and reversed it to a loose wrap .So far everything has been going great .No more tight complctions and discomfort i had all time in chest .While he was doing it realize it was starting to colapse and that s why i was having more and more issues my food was getting stuck.I am keeping myself on liguid diet for at least 6 months to make sure all heals well and no issues.So pleased with the reverse ...My surgeon was especially pleased with my results so far ......

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Greg today was terrible, drank some Maalox and took some acid blocker hope to sleep through the night. You had the surgery ay Mayo? Have you done enough research to find out who deos the best reversal. I live in Cincinnati, I know it has to get better than this. Thanks Dennis

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@deb1987, simply said... YAY! Thanks for the update!

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Hey Dennis. I know your pain buddy. I haven't researched the reversal yet. I'm going to get scoped this Tuesday ( north and south pole) because this GI thinks I've got more than one thing going on. I literally have made my peace with God three times. Even though I did have a hernia, this doc says there's a reason for so much acid. That reason he explained, is my body trying to control the bad bacteria in my small intestine. Well, over time somethings gotta give, and I developed GERDS. I've missed some work, but it's getting worse. And I too am worried. My stomach, chest, or guts hurt all the time now. I'm being checked for Celiac disease, Crohns, diverticultis, IBS, and some others. Once I get these results I will see what this GI recommends. I will also talk to him about benefits of a reversal. I did have mine done at Mayo in Phoenix. Awesome female surgeon. I won't ever go for surgery anyplace else. The only two things that give me some relief are, nexium, and keeping something in my stomach. I have been to a holistic doc. Spent about $600.00 on supplements. Got some relief. Short-lived though. My advice Dennis, for what it's worth is to see if you've got something secondary that's causing your symptoms. In the meantime, I will be researching the pros and cons of a reversal and let u know what I find out ok. Hang in there buddy. I know it's miserable. But you're not alone. I'm on the Internet every night talking with people about this. There's an overload if opinions though. It's hard to sort through it all, but I'm pretty damn perserverant, and tired of feeling like this. Try nexium for now is all I've right now. You may have also developed ulcers post surgery like I did. Take care.

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@robatk17 thank you for posting here. I'm hoping you can find some answers to your questions, and some comfort in what I'm about to write. You've certainly been through a lot and have multiple things to take into consideration. I'll try to address as much as I can.

If this issue is bothering you enough to post on here, I would certainly address the issue, but you may need to keep advocating for yourself and at a different medical center. I feel that no one should ever have to "settle" with their health.

Regarding the Nissen, I just had a Nissen done at Mayo - Rochester last October, and I wish I had done it a decade before. My sphincter no longer functioned, and they fixed my 4cm hiatal hernia. I have no GERD now, I can eat normally again, and I can sleep laying down like a normal person again. It has enabled me to completely stop taking PPIs, H2 Antagonists, and antacids. I assume that if you have the Nissen undone versus redone, you will have to take some of these medications, which despite what many doctors advise and prescribe, were not intended for long-term use (i.e., years and years and years). These medications can also inhibit the liver enzymes that your body uses to metabolize other medications, which will cause your body to not properly-metabolize them. And I believe that you will also have a fairly significant GERD issue since there is already a hernia with the Nissen. Before my Nissen, I used to wake up with partially-digested food that had traveled up to the top of my esophagus, and I would wake up coughing and choking on it. You don't want to aspirate this stuff into your lungs. GERD can also cause asthma.

With that said, if you have the Nissen redone, I would ensure to go to a thoracic surgeon who has ample experience with Nissen fundoplications and also with correcting them.

Regarding the MALS, if Stanford doesn't feel it is a legit condition, what do they think is going on with you? (My frequent stressors at my home medical center have been doctors who figure out what they think isn't wrong with me, but they take no further steps to figure out what is wrong with me. This is actually why I took myself to Mayo.) I would definitely get a second opinion from another high-caliber institution.

As an aside, I have many doctors at Mayo in many different specialties, and I have never had anyone treat me in the manner that it seems those vascular specialists treated you, which has affected the opinions of other physicians there, as well. You didn't go there asking for more drugs; you went asking to fix a medical problem that in itself is a lot to deal with on its own. (My mom and daughter have peripheral neuropathy, so I can somewhat understand.)

Don't apologize for being angry; I absolutely understand as I have been there myself and still feel anger toward my former doctors, but it is getting better. What two of my home medical centers and 20 doctors weren't able to figure out for 12 years -- ultimately telling me that there was nothing wrong with me -- Mayo Clinic figured out in only the first six months I went there. Ends up there were a ton of things wrong with me, many undiagnosed and some actually caused by my home doctors.

Mayo's doctors have helped me with one very important thing: I'm learning to trust doctors again. It can happen for you too, once you meet the right people.

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