Reversal of a fundoplication

Posted by Pawsboy9 @pawsboy9, Aug 5, 2012

I had a hernia and the fundoplication done in February as post this my chest is on fire. Going back to see the surgeon who did it on Tuesday. Has anybody had the same experience? If this guy does not have a answer heading for Mayo.

Thanks
Dennis

@kdubois

Hi @kozlo52,

I had a Nissen Fundoplication at Mayo on October 18, 2016 to fix a 4 cm hiatal hernia and non-functioning sphincter muscle. Pre-surgery, I would constantly have heartburn and GERD. I would have to finish dinner before 6:00 p.m. every night, and sleep upright using a bed wedge or I would wake up choking on with partially-digested food and stomach acid. (We did the surgery to fix these issues but also because Mayo figured out that genetically, I don’t properly-metabolize many medications, including proton pump inhibitors.)

Since the surgery, I have had no GERD or heartburn, and I can sleep normally and eat at normal times again. Post-surgery, I did take NSAIDS for pain for about two weeks.

Important to note: to test my fundoplication post-surgery, Mayo had me do an esophagram and not another manometry. The esophagram will better-show that fluids aren’t coming back up into your esophagus as it’s a true imaging test and they can literally watch the fluids (barium) real-time while you consume them.

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@kozlo52 I don’t have to eat several small meals every day anymore, and haven’t for a while. I only take Advil every once in a while, but I have never experienced heartburn from it. I honestly haven’t experienced any heartburn since I had my surgery on October 18.

I do stop eating immediately when I feel myself getting full, but I have over-eaten a couple of times and had no heartburn.

They *really* need to do an esophagram to see if there are fluids coming back up. This test includes imaging while you are standing up straight but also while you are laying down and rolling around in circles. I would ask them to perform an esophagram.

How frequently are you experiencing the heartburn? Daily?

Hi @onejoe, I agree, your wife needs a very experienced surgeon, but it’s nice to see that her local surgeons are willing to admit that they aren’t experienced enough. A consult at Mayo – Scottsdale is an excellent idea if you are in California, though I can only speak on my personal experience with Mayo – Rochester. (I had my Nissen done at the Mayo – Rochester by a thoracic surgeon named Dr. Francis Nichols. He’s been doing these surgeries for more than 30 years, and I’d bet my life that he’s done tons of corrections, redone these surgeries, etc. He’s very nice, has a great bedside manner, and also a great sense of humor.)

As an aside, my brother had a Nissen fail a few years ago after he became sick… coughing and sneezing for several months made his Nissen fail. He had his redone at UVA (he lives in Virginia) a few years ago, and it’s been good ever since! These can be successfully redone!

@kdubois

Hi @onejoe, I agree, your wife needs a very experienced surgeon, but it’s nice to see that her local surgeons are willing to admit that they aren’t experienced enough. A consult at Mayo – Scottsdale is an excellent idea if you are in California, though I can only speak on my personal experience with Mayo – Rochester. (I had my Nissen done at the Mayo – Rochester by a thoracic surgeon named Dr. Francis Nichols. He’s been doing these surgeries for more than 30 years, and I’d bet my life that he’s done tons of corrections, redone these surgeries, etc. He’s very nice, has a great bedside manner, and also a great sense of humor.)

As an aside, my brother had a Nissen fail a few years ago after he became sick… coughing and sneezing for several months made his Nissen fail. He had his redone at UVA (he lives in Virginia) a few years ago, and it’s been good ever since! These can be successfully redone!

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Thank you Kelly, we are considering Mayo in Scottsdale but am also looking at UCSF or Stanford as possibilities. It is heartening to hear of any sucess stories. If I still lived in Massachusetts We would certainly go to Rochester, i am glad you had good results. Thanks again. Joe

Dennis, My 20 year old son (who was born with a congenital problem of his stomach) He had his 2nd NF of his life in 2014. That surgeon did the wrap too tight and too high up on his esophagus. He lost 30 pounds and currently has a feeding tube due to other health problems because of the too tight NF. Please go online and look up on youtube. Steven P Bowers MD – Jacksonville Mayo. Instead of doing yet another NF on my son he inserted and performed augmentation of the linxs device. magnetic beads form to close and open with food. It is a fairly new procedure hopefully it will take over as the standard not many surgeons know of it. I would highly recommend it. The evening of surgery you are able to eat real food. In fact it’s encouraged to eat to keep the beads moving so not to fuse over. Good luck.

The LINX device is awesome, and being able to eat the same day is super-awesome.

With that said, note that not all insurances will cover it (probably because it is new), and it can’t be used if the hernia being repaired is too large. My hernia was 4cm and Mayo told me it was too large to use the LINX.

@onejoe

My wife had a Nissen Fundoplication in January 2014. ( that surgeon is now retired) For the past year symptoms have become progressivly worse and we were recently advised that the Nissan wrap had failed and was now herniated into her chest cavity. Local surgeons advise redoing the surgery is beyond their expertise. (Eureka ca) and advise going to larger hospital. Mayo Scottsdale was suggested as having Doctors experienced in this proceedure. We certainly want someone with a lot of experience. Any advise or suggestion greatly appreciated. Thank you Joe

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I had my N fundoplication redone at Mayo in Scottsdale by Dr. Richard Schlinkert in 2012, and it has held wonderfully.

@onejoe

My wife had a Nissen Fundoplication in January 2014. ( that surgeon is now retired) For the past year symptoms have become progressivly worse and we were recently advised that the Nissan wrap had failed and was now herniated into her chest cavity. Local surgeons advise redoing the surgery is beyond their expertise. (Eureka ca) and advise going to larger hospital. Mayo Scottsdale was suggested as having Doctors experienced in this proceedure. We certainly want someone with a lot of experience. Any advise or suggestion greatly appreciated. Thank you Joe

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Welcome to Connect @mariann, and thank you for sharing the information. Do let us know if you have any questions.

kelly, since your fundo was very successful how long were you on the liquid diet; the semi solid diet; then the solid diet. I just had another endoscopy on march 16, 2017 and a esophagael manometry the same day. I meet with the surgeon on march 23, 2017 and we will discuss all the results. His other surgeon who did the above tests tell me that i am eating too large portions. That will cause the stomach to push on the diaphram and that is the pain i am experiencing. Now on sunday march 19 i ate smaller portions ( 3 meals per day) and had no problems with heartburn. i did get a migraine ( flashing lights and aura) and settled on tylenol for that. The next day to prevent continuance of the migraine i took one of my fioricets adn it did help the head but got terrible heartburn. The same thing happens if i use mobic (NSAID). I will request an esophagram to be done. After 4.5 months i should not get heartburn , even being on antacids. i do have a problem with headaches which the neurologist and neurosurgeon think is related to my C3-C7 stenosis, but i can’t get to the neurosurgeon because of all these post fundo problems. Any other advice would be appreciated…..thank you… kozlo52 (Paul).

Hi Paul @kozlo52, the schedule Mayo gave me to follow post-surgery was very different from those I researched online beforehand, which was nice to learn.

Th instructions they gave me were full liquid diet for two weeks followed by soft diet until my follow-up appointment, which was in December. My surgery was 10/18/2016, and I was able to eat a small Thanksgiving dinner. They gave me a four-page handout of the soft diet food to eat; it included foods that were okay and also foods to avoid during this timeframe. I still stick to smaller meals, but I also struggle with remembering that I need to stop eating as soon as I start to feel full.

From what I have recently learned (one of my friends is a pharmacist), it is very common for NSAIDS to cause heartburn, and fioricet and mobic contain an NSAID.

Moving forward, I would avoid NSAIDS. It sounds as if you experience traditional migraines (aura); have you ever tried migraine meds, such as sumatriptan? These do not contain NSAIDS.

With that said, I would still definitely request an esophagram because of the frequency you are having heartburn.

Kelly, this is kozlo52(paul). yesterday i found out the results of my biopsy and esophagael manometry results. Now the biopsy showed no barrett’s dysplasia. ( this is the 3rd time that the barret’s dysplasia did not show up). initially it did show up prior to fundo. The esophagael manometry showed that my peristalsis had dropped from initially 70 (prior to fundo) to 30 now. The surgeon does not know why. This indicates that the esophagael muscles are working less than before. I’m very disgusted with the whole mess. The surgeon feels that after we do an esophagram on wed., march 29 that he may also want to redo the bravo ph test asap and feels that i may need a 270 degree wrap. Does this make any sense? I am not sure of this surgeon and staff. I am very inclined to just have the fundo undone and fight this thing with antacids as prior to the operation. i need to address the continuing headache issues coming from the neck. The surgeon says with a 270 degree wrap the esophagael muscles won’t have to work as hard to push food thru. These operations are very hard on my body, since I have RA. what do you think of these results? Yesterday after i came home in the pm, between the headache and heartburn i was feeling very sick……thanks paul

Hi Paul @kozlo52, I’m glad to hear that they are doing the esophagram and that they are doing it soon. Your surgeon is correct that if your esophageal muscles aren’t pushing downward hard enough that you need a 270º wrap versus a 360º wrap, but i’m unsure how this would alleviate your heartburn issues. (Maybe there’s something that you and I aren’t aware of that contributes, but I would specifically ask him how this would help with the heartburn issue.)

I understand that they would want to do a Bravo, as well. They want to measure your acidity levels. For me, on two different occasions (at home and at Mayo), they went in to do the Bravo but never attached the device because they could visually-see how much esophageal burn I had. Note that prior to the Bravo, you need to cease taking all PPIs, H2 Antagonists, and Tums-like medications, I think for a week.

Having these tests are good, but you seem to have a lack-of-faith in your current surgeon, which I think at this point is understandable. If I were you, I would move forward with at least the testing. With that said, are you in a position to be able to obtain a second opinion?

I am concerned with having the Nissen undone, that you’ll have side effects from long-term use of medications and you may likely still experience GERD, which can cause other health issues (it caused me to have mild asthma and I would wake up almost-aspirating my food).

And with all of that said, are you able to go to Mayo? They use a very patient-centered, team approach and the various specialists ensure to review each other’s clinical notes about you and communicate with each other to ensure the best strategy to work on all of your conditions.

@kdubois

Hi Paul @kozlo52, the schedule Mayo gave me to follow post-surgery was very different from those I researched online beforehand, which was nice to learn.

Th instructions they gave me were full liquid diet for two weeks followed by soft diet until my follow-up appointment, which was in December. My surgery was 10/18/2016, and I was able to eat a small Thanksgiving dinner. They gave me a four-page handout of the soft diet food to eat; it included foods that were okay and also foods to avoid during this timeframe. I still stick to smaller meals, but I also struggle with remembering that I need to stop eating as soon as I start to feel full.

From what I have recently learned (one of my friends is a pharmacist), it is very common for NSAIDS to cause heartburn, and fioricet and mobic contain an NSAID.

Moving forward, I would avoid NSAIDS. It sounds as if you experience traditional migraines (aura); have you ever tried migraine meds, such as sumatriptan? These do not contain NSAIDS.

With that said, I would still definitely request an esophagram because of the frequency you are having heartburn.

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kelly , i had an esophagram on march 29, 2017 and the results show that liquid is still not getting all the way thru the LES. This means that the wrap is still too tight. They want to do another 48 hour bravo because they want to determine if my heartburn is due to backup at the LES or acid backflow.. If I take either mobic or fioricet i do get bad heartburn because the surgeon team says that the pilee are not getting thru, but sitting on the ledge created by the fundo. Yet when i take an oxycodone i don’t get the heartburn. I seem to get very conflicting info. I also had my gall bladder checked by ultrasound and they did find a gall stone. i don’t know what i am going to do about this until i get more info…. paul @ kozlo52

@kdubois

Hi Paul @kozlo52, the schedule Mayo gave me to follow post-surgery was very different from those I researched online beforehand, which was nice to learn.

Th instructions they gave me were full liquid diet for two weeks followed by soft diet until my follow-up appointment, which was in December. My surgery was 10/18/2016, and I was able to eat a small Thanksgiving dinner. They gave me a four-page handout of the soft diet food to eat; it included foods that were okay and also foods to avoid during this timeframe. I still stick to smaller meals, but I also struggle with remembering that I need to stop eating as soon as I start to feel full.

From what I have recently learned (one of my friends is a pharmacist), it is very common for NSAIDS to cause heartburn, and fioricet and mobic contain an NSAID.

Moving forward, I would avoid NSAIDS. It sounds as if you experience traditional migraines (aura); have you ever tried migraine meds, such as sumatriptan? These do not contain NSAIDS.

With that said, I would still definitely request an esophagram because of the frequency you are having heartburn.

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Hi Paul @kozlo52, so glad they finally did an esophagram, but it’s a bummer that the wrap is too tight. With that said, it sounds like they are actually working to figure this out, especially with wanting to do another Bravo. It seems that NSAID use definitely affects your heartburn levels; Oxycodone doesn’t contain an NSAID, so that could be why you don’t get heartburn when taking it. As testing progresses, you’ll have to decide whether or not you want to continue with the same doctors. I would ask them how many reversals they have done, what you should expect to experience afterward, if you can have another Nissen done eventually afterward and if so how long you have to wait. With that said, if you continue to feel uncomfortable with their responses / actions, you are always entitled to a second opinion.

I had my gall bladder removed a few years ago by a general surgeon here at home. It required three or four abdominal incisions and was actually a very brief surgery. It went well, and I went home the same day with a drain that needed to be removed a week or two later. I feel better without the gall bladder.

Keep us posted… ~ Kelly

Hi my name is Deb.I had my Nissan done over 3 years ago .I have had nothing but pain ,in upper chest ,upper back ,terrible heartburn.Feel like i constantly have soar throats and something is stuck .Always bloated and whole body swollen .Food and drinks constantly get stuck .Takes almost 20 minutes of me feeling like i am choking and getting food with lots of flem to come back up .Since the wrap , I have been diagnosed with Bloating syndrome , IBS syndrome dumping syndrome, one doctor says I have a espogeal spasms one says no i don’t .I have had my esphogus dilated more times then i can count .
Gone back to my surgeon 4 times in last 3 years since .Last two times i went to him said we could loosen it but want second opinion .So of causecsends me to his partner.He does edg says yeah it’s to tight then does barium swollow ,which shows my esphogus closing up .But says on it’s not your wrap it’s espogeal spasms .Im like really .So go back to surgeon now he saying i really don’t want to do it “Go back to your GI Doctor see what she can do .I am getting so tired of all these doctors .I am in constant pain all the time .All i want is to either loosen the thing or up do it .Does any one in Colorado or close to Colorado know of any surgeons that will undo the wrap .I have not felt like my self since this thing .

@deb1987

Hi my name is Deb.I had my Nissan done over 3 years ago .I have had nothing but pain ,in upper chest ,upper back ,terrible heartburn.Feel like i constantly have soar throats and something is stuck .Always bloated and whole body swollen .Food and drinks constantly get stuck .Takes almost 20 minutes of me feeling like i am choking and getting food with lots of flem to come back up .Since the wrap , I have been diagnosed with Bloating syndrome , IBS syndrome dumping syndrome, one doctor says I have a espogeal spasms one says no i don’t .I have had my esphogus dilated more times then i can count .
Gone back to my surgeon 4 times in last 3 years since .Last two times i went to him said we could loosen it but want second opinion .So of causecsends me to his partner.He does edg says yeah it’s to tight then does barium swollow ,which shows my esphogus closing up .But says on it’s not your wrap it’s espogeal spasms .Im like really .So go back to surgeon now he saying i really don’t want to do it “Go back to your GI Doctor see what she can do .I am getting so tired of all these doctors .I am in constant pain all the time .All i want is to either loosen the thing or up do it .Does any one in Colorado or close to Colorado know of any surgeons that will undo the wrap .I have not felt like my self since this thing .

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I had my original Nissan fundoplication at another hospital and continued to have problems. Then it was redone 5 years ago at Mayo Clinic in Arizona by Dr. Richard Schlinkert. I was and am still very pleased with the results.

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