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POEM Surgery for Achalasia
Hi everyone,
I’ve had achalasia that progressively got worse over the course of three years, to the point where I almost couldn’t eat without throwing up, and drank at least a liter of water with every meal. I just had a POEM surgery done in November (2017) with Dr. Robert Bechara in Kingston, Ontario. I wanted share my experience because, like many people here, before my surgery I scoured the web for hours trying to get an idea of what I should expect. I ended up being very anxious about the surgery, afraid that it wouldn’t work or even make things worse. I now know I fell victim to confirmation bias, since people are much more likely to post a bad experience rather than a good one, and I want to dilute that a bit.
Like many, I was first diagnosed with GERD and took Proton Pump Inhibitors, which obviously didn’t work. After a barium swallow, endoscopy, and mamotomy (ugh), I was correctly diagnosed with Type I achalasia and was lucky enough to be scheduled for POEM only three months later. Dr. Bechara and his staff were incredibly friendly, communicative, and accommodating to the fact that I lived out of province. Dr. Bechara studied in Japan, where the procedure was developed, and had a success rate of 100% from 100 patients that he’d done the operation on. Contrasting to how nervous I was, he seemed to almost be bored. In fact, the day I had my operation, he had another person getting it too. So, he’s a total expert. Do ask your doctor how many operations they’d done and if they had any complications, if nothing else it’ll put your mind at ease.
Three days before the operation I was on a fully liquid diet, which isn’t bad but really drains your energy. All I wanted to do was lay in bed and watch TV, so don’t plan any marathons. The morning of the surgery I was put on IV and right before the surgery I was knocked out and put on anaesthetic. All I remember is the count down, and the next thing I knew I was coming to in the post-op room. At first the anaesthetic was still working so I felt sleepy but great. As it wore off though, I started feeling a pain in my chest. Getting up was out of the question for at least a few hours, but they gave me a fantastic pink numbing liquid (Lidodan 2%) which worked wonders. I was pretty much bedridden for the next three days, and had almost no energy for anything. So take that week off work is my advice.
This pain remained for about three weeks, and, I’ll be honest, it really sucked. At first it was a constant dull pain that inhibited my breadth of movement and would only be subdued by the pink stuff. After about a week the pain became acute, which was worse. I would feel almost totally fine, and then this sharp stab would suddenly come on and I had to lie down wherever I was; always have your pink stuff (or Tylenol) on hand. I thought these was the spasms some people wrote about in blogs and was afraid it wouldn’t go ever away. I definitely had thoughts that this wasn’t worth it, and I should’ve just lived with the swallowing issues rather than inhibiting spasms. BUT, the pink liquid was awesome and it would calm the pain in about 30 minutes, and it did go away after three weeks. It became less and less frequent, and now totally gone. The pain is not that surprising really, they put a 17cm incision inside your body – its gonna hurt. After a week after the surgery I was able to work just fine.
Right now, two months post-surgery, I feel so incredibly grateful that I had the operation done. I can eat all my favourite food not only without throwing up, but with consuming only a small amount of water (often not even necessary). I’ve started feeling thirsty again, can eat until I’m full, and have finally started regaining the weight I’d lost. If you have a chance to do this operation, do it. And I would highly recommend Dr. Bechara if you have the opportunity. Good luck, and don’t give up hope!
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Hello, I hope you are doing well. Have you had the surgery already? How are you feeling?
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1 ReactionHello, thanks for your reply. I am that your PEOM surgery went well, sorry to hear about the reflux but, as you mentioned, it is one of the side effects of the surgery. Yeah, I will definitely try to slow down and stick to soft solid food as much as possible. How long after your surgery did you notice an improvement? I guess that is my main concern, just not knowing how long it will take for things to get back to normal. I spoke to my surgeon about my issue last Wednesday and he said that it usually takes time to it to improve. I will have to wait and see, hoping that the surgery was worth it, I am already looking at what other options may be out there if this does not work. I only had surgery on the LES, wonder if there is a need to expand the surgery, I guess only time will tell. Good luck to you as well keep us posted. Ah, one more question for you, was the feeling of food stuck in your throat one of your symptoms prior to surgery?
Hi. I didn’t have that feeling post surgery but you are still healing. Try slowing down your eating and taking smaller bites. Of course you will address this at your follow up visit with your surgeon. I recall Jen’s husband (who has posted on this site) had difficulty swallowing post op and gradually improved. I hope swallowing improves for you as well.
I do want to share my current status. My surgery was in January 2019. I developed reflux which is a side effect of POEM. I was fine for several months and then it started. I was warned by my surgeon that reflux was a possibility. Now I am attempting to make dietary adjustments and have included alkaline water to raise my ph. I may have to return for a fundoplication procedure for the reflux if my efforts in diet change are unsuccessful. All the best to you.
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2 ReactionsHello everyone, so glad I was able to find this site. I had PEOM exactly 2 weeks ago since I was diagnosed with Esophagogastric Junction Outlet Obstruction (EGJOO) some doctors called it "early Achalasia". I am a bit worry now since I am still getting the feeling of food stuck in my throat, has anyone experienced this post-surgery? I have a feeling that unfortunately for me the surgery did no help. Any feedback would be greatly appreciated.
Hello ... may I ask if you have achalasia ? and if so which type ? And how your procedure went. And how are you now ? Thanks !
Thanks again ...keep well x
I don’t think I did. It was described to me as making a tunnel through the muscle to get to the esophageal sphincter and the clips are at the site of the incision to the tunnel. I know you have extenuating circumstances with the jackhammer. I have to tell you Fran I was beside myself with fright and had I known then what I know now post op I would have been calmer. The surgical team treated it like a walk in the park and in hindsight the only challenge was feeling weak while waiting to return to a normal diet. This is a noninvasive procedure and recovery was uneventful. I took one week off from work. I hope this helps allay your fear.
That’s fantastic Margaret . I’m glad it worked out so well for you. Sorry to keep asking questions , but was it just the LES muscle that was cut , or did the doc cut the oesophagus also? I am to have what’s called an extended P.O.E.M which means the LES and the whole length of the oesophagus will be cut. This is because of the Jackhammer as well as the achalasia. 😮 frightening !
Post op it is routine to be placed on antibiotic, anti nausea and reflux meds. The antibiotic for me was levaquin as I’m allergic to penicillin. I took that for four days. The anti nausea I didn’t take because I had no nausea but was told that for those who do it is a must to take because you cannot vomit or you can lose the clips at the site of the incision. Finally I was given pantoprazole for reflux. I think I was on that for two months post op. I needed the reflux med. I had discomfort those first two months but it was manageable. The script ran out and the dr didn’t want me to continue with it because he wanted to see if I could function without it and I did. I was told there is a percentage of patients who develop reflux from POEM and in that event the dr said they can do another procedure called a wrap. Also going forward I am to have a yearly endoscopy. I’m on no meds now.
Thank you Margaret ... just one question , are you on any medications ? And how is the reflux doing. ?