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Fri, Mar 13 8:05am · Hiatal Hernia - Surgery & Complications in Digestive Health

Hi @marlaxyz,

In October 2016, I had a Nissen Fundoplication at Mayo Clinic in Rochester, MN.

It was done laparoscopically (five abdominal incisions).

It was perfumed by a very experienced thoracic surgeon. I would only have this procedure done by a thoracic surgeon who has done hundreds of these surgeries as I have heard many stories about these surgeries not performed properly.

My nissen was PERFECT! It totally cured my GERD and hiatal hernia. I haven’t had even a spot of heartburn since.

Tue, Feb 4 10:30am · Gastroparesis Diet – Questions, Suggestions, Tips in Digestive Health

Hi @debnjay, welcome.

You’ve certainly been through a lot. At this point, I think you have taken the right step in consulting with Mayo at the end of this month.

After 12 years of building GI issues, and doctors at home giving me the run-around, my Minnesota Mayo GI/Hepatology doctor and thoracic surgeon have me in a better place now than I was for the previous 12 years.

Mayo will definitely do what’s necessary to figure out what’s going on and also figure out the best steps to take to make you whole again. I’m actually surprised by how much better my health is now, and I never thought I’d be this whole again. It’s all thanks to Mayo, and a large part of my recovery was due to the team you are seeing soon. Please keep us posted!

Tue, Feb 4 10:10am · Reversal of a fundoplication in Digestive Health

@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.

Tue, Feb 4 10:10am · Reversal of a fundoplication in Digestive Health

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

Mon, Feb 3 9:09pm · Nissen Fundoplication in Digestive Health

Mayo did call it “large” in all of my imaging from the past year.

The only medical center I know about in NYC is Mount Sinai, and it’s pretty large and well-known.

If it’s any help, I’ve also had my gallbladder removed (age 40) and had my appendix removed in 1991 with a four-inch incision (age 19), and this fundoplication surgery was *much* easier on me than those two were.

The biggest plus is that the surgery allowed me to stop taking all of those proton pump inhibitor drugs. These drugs were NOT intended to be used long-term — I think no more than 14 days or so. And here’s a very important fact to know… even if you don’t have genetic polymorphisms like I do, drugs like Nexium (esomeprazole) inhibit the liver enzyme that your body uses to metabolize all medications that are also metabolized via that enzyme. It basically slows down the your body’s ability to get that drug out of your system. Nexium actually inhibits the enzyme that it itself needs to be metabolized. And if you are on any other medications that are also metabolized by that enzyme, it slows down the metabolization of those meds, too.

Unfortunately, the overwhelming majority of doctors out there have such a rudimentary understanding of this system (called cytochrome P450), that they have no clue about the ramifications of long-term use of certain drugs like this. Frankly, I’m *stunned* by how little doctors know about this system of the body and how each drug they add or remove from a patient’s regimen can morph how the patient’s entire drug metabolization methodology.

Mon, Feb 3 9:09pm · Nissen Fundoplication in Digestive Health

I just saw your question regarding polymorphisms.

Mayo figured out that I have multiple cytochrome P450 liver enzyme drug metabolization polymorphisms. P450 is a huge system in our bodies that does different things. Part of it is in the liver and consists of a bunch of enzymes that help us metabolize medications, hormones, and toxins. Mayo figured out that a bunch of my enzymes are polymorphic, meaning they are mutated, causing me to improperly-metabolize many medications, which I had been taking for years. One of these medications was Nexium and its generic equivalents. The thing is, even if you don’t have polymorphisms like I do, you can still be negatively affected because many drugs inhibit these enzymes from working properly. Nexium even inhibits the very enzyme that it itself needs to be metabolized, so if you take it for a super-long time, which for me was 12+ years, it can make you sick, like it did me.

Mon, Feb 3 9:09pm · Nissen Fundoplication in Digestive Health

My surgery went very well, and I’m so glad that I had it done! I don’t have to sleep sitting up anymore. I don’t have to avoid certain foods anymore. I NEVER have heartburn/GERD.

Here’s how it went:
• My husband and I flew into Rochester on a Sunday.
• The next day, I had a pre-op appointment with my surgeon and a PA, and I did my pre-surgery labs. (They also had me do one imaging test to check the functionality of my esophagus because some of my tests the August before indicated that it didn’t always function properly, but they found that it does.)
• The surgery was on a Tuesday, and I was discharged Wednesday afternoon.

Mayo will allow you to fly home the same day you were discharged if you want to. I chose to stay until Saturday.

They will give you food guidelines because you can’t just eat normally right away.

The follow-up imaging is done at your home location, and you then mail Mayo a CD of the imaging. After they review it, they will call you for the follow-up appointment.

Weirdest thing is that most of the pain was in my shoulders afterward despite that I had five abdominal incisions. Apparently, this is normal because while performing the surgery, they fill your tummy up with gas (CO2, I think). They only way for the gas to dissipate from you body is for it to rise up to your shoulders. They will give you pain meds for this. (I can’t take pain meds, so they put some kind of warming device on my shoulders, and when I was back at the hotel recovering, I used ThermaCare.)

I would not go to a general surgeon for this. Here’s why… they needed to detach my diaphragm, esophagus, and stomach and move them about two inches lower. They then tack everything down, and then they perform the wrap of the stomach around the base of the esophagus. (If the esophagus is performing correctly, which they figure out via an imaging test called an esophagram prior to the surgery, they will do a 360º wrap of part of the stomach around the base of the esophagus. If the esophagus doesn’t, then they perform a 270º wrap of the stomach.

Mon, Feb 3 9:09pm · Nissen Fundoplication in Digestive Health

I believe what you want is a thoracic surgeon.

Have you been to Mayo before? They will likely want you to meet with a GI doctor first, and they will then order testing and maybe some labs. You usually don’t get to choose which doctor you get, but that’s okay because they are all great.

I see Dr. Jeffrey Alexander in GI. He then finds a thoracic surgeon. My thoracic surgeon is Dr. Francis Nichols.

I first met Dr. Alexander in January 2016.

I had a follow-up with him in August, and at that time he said that I was now a candidate for the surgery because I had lost some weight, was healthier, and they had also learned that I cannot take PPIs due to genetic issues. He asked if I could stay a week longer to do the testing and have a subsequent follow-up with him and the surgeon because I lucked out and another patient had just cancelled all of these same appointments I needed.

At the follow-up, I met with him again, and then he pulled a thoracic surgery PA and Dr. Nichols into the room. We talked everything over, and Dr. Nichols then pulled his schedule/calendar up on the computer screen and we picked a surgery date.