Has anyone had nissen fundoplication?

[frh]

My quest to stop the irritation in my esophagus led me to an appointment with a surgeon this morning. After reviewing my endoscopy and upper GI results, he said he would like to do a "Nissen fundoplication" http://en.wikipedia.org/wiki/Nissen_fundoplication. He said now th the surgery is done with an endoscope so there will be very little scarring and the recovery will be a lot easier than it used to be.

Has anyone had this procedure? Did it work? What was your experience with it?

[BlackSpinner]

They are sticking a fun car down your throat?

[LSAT]

I had the nissen done 8 years ago. It was done laporoscopically....5 small slits in the stomach. I have never read anything about it being done through the esophagus. There ARE several other procedures that ARE done through the esophagus, but, not the nissen. The web site you are referring to shows the nissen being done outside the esophagus. It involves wrapping the upper part of the stomach around the outside of the esophagus. (Can't do this from inside the esophagus).

The surgery did help me. I have not taken any meds since the surgery. However, everyone is different and the surgeon
is the key in having a successful outcome.

[frh]

I did not mean to imply the surgery was being done through the esophagus. It is being done to relieve the discomfort I have been having in my esophagus.

[Janknitz]

A lot of people with the syndrome I have-- Noonan's Syndrome--have severe reflux issues (interesting that the small jaw is never considered a factor in this!) and many of the infants and young kids with severe reflux end up with Nissens. I think the procedure is generally tolerated well and helps a great deal in these kids, but have no personal experience with this.

Interesting that I was having very severe reflux prior to CPAP, but when my CPAP is on I don't have any. I can tolerate food later at night and drink milk in the evenings--two things guaranteed to cause a bad bout of reflux before CPAP. But if I'm not wearing my CPAP even for a short afternoon nap, look out

[Arizona-Willie]

I had a laparoscipic nissan fundoplication at Mayo in 1999.

Fantastic !!!

Still good. Can eat anything, no problem with the reflux anymore.

Go for it.

[Julie]

It's been done for years on many patients and there's nothing to worry about !

[frh]

Thanks for the answers. The doc said I would spend 4 days in the hospital (or until my bowels started working) and I shouldn't plan on working for 2 weeks. But the opportunity to work doesn't come up that often anymore, so most likely if I can, I will. That is, if it is not likely to tear the stiches, etc...

Can anyone elaborate on what the recovery was like?

[LSAT]

I would doubt that you would need 4 days in the hospital. Most of the people that I'm aware of that have had this surgery were in and out in 1-2 days. In my case I went in on a Thursday AM with a plan to go home Friday AM. I had a swallowing problem on Friday and was not released until Saturday. I was 62 at the time of my surgery and was working in an office. I was back to work part time in a week. I had very little pain and used nothing stronger than Tylenol. Liquid/Soft foods
for 1-3 weeks gradually moving to more solid foods. Bread and steak at the very end. It has now been 8 years for me and at my last EGD my GI said the wrap still looked good. There are very few stitched involved with this surgery so I would not be concerned with tearing.....unless you are a weight lifter..

[mars]

Thanks for the answers. The doc said I would spend 4 days in the hospital (or until my bowels started working) and I shouldn't plan on working for 2 weeks. But the opportunity to work doesn't come up that often anymore, so most likely if I can, I will. That is, if it is not likely to tear the stiches, etc...

Can anyone elaborate on what the recovery was like?

Hi frh

I had a fundoplication done about 3 years ago by laparascopic surgery.

Because they did not do a 24 hour ph test afterwards, and I had silent GERD, it was over a year before, on my insistence, that another ph test was done. The fundoplication was a complete failure, and my reflux was worse than before.

By the way, the surgeon says that the operation was a complete success, as have other Gastroenterologists who have examined it. The fact that it did not work does not seem to bother them.

My Barretts Esophagus was unprotected for 12 months.

So much for the surgeons guarantee of success.

The fundoplication can also lose effect after 2-3 years, and many fundoplication patients still have to take PPI's after the operation.

There are different reports of how successful it is, from 50% to 95%. I would not have had the surgery if I did not have Barretts Esophogus.

The surgery is minimally invasive, and I was out of hospital in 2 days, and back to normal.

Ask your Doctor about the failure rates and see what he says. Failure being measured by a ph test, not by how nice the fundoplication looks through an endoscope.

Does he do a ph test after the surgery, I would not trust him if he did not. If you have the surgery, insist upon having a 24 hour ph test afterwards, no matter what the Doctor says about how successful it was.

cheers

Mars

.

[frh]

Thanks Mars, I will ask him about that. I have not felt "heartburn" in several years. What I feel is irritation just below the voicebox, and sometimes it makes my voice a bit raspy. This irritation started one morning last November when I was riding hard on my recumbent bike. After my knee replacement surgery, I got up to 5 to 10 miles, three times a week, and lost 30 pounds in 4-1/2 months. I have not been able to ride since and gained the 30 pounds back. I am taking 40 mg of protonix twice a day and 1 gm of sucralifate four times a day. That controls it for the most part, but things like lifting anything heavy or bending over to tie my shoes makes causes irritation. CPAP and raising my bed about 6" keeps it from bothering me at night.

The endoscopy report says " There were mucosal changes suspicious for short-segment Barrett's esophagus present in the lower third of the esophagus." it went on to say "There was deformity from scarring probably from acid reflux." (The biopsy said I do not have Barretts, but the surgeon said it could become Barretts without the surgery.) The upper GI report said "Several episodes of spontaneous gastroesophageal reflux were observed, with contrast material reaching the upper esophagus." The surgeon said it is not likely to get any better without the surgery. Truth is, I am tired of not being able to do much of anything more strenuous than sitting around getting fat. If they can get it scheduled before the end of the month we have insurance that will pay 100% of the cost.

[Guest]

I had it done for my hiatal hernia. Was home in two days. Some eating restrictions for a few weeks, bot other than that healed up in no time.

[SleepingUgly]

What I feel is irritation just below the voicebox, and sometimes it makes my voice a bit raspy. This irritation started one morning last November when I was riding hard on my recumbent bike. After my knee replacement surgery, I got up to 5 to 10 miles, three times a week, and lost 30 pounds in 4-1/2 months. I have not been able to ride since and gained the 30 pounds back. I am taking 40 mg of protonix twice a day and 1 gm of sucralifate four times a day. That controls it for the most part, but things like lifting anything heavy or bending over to tie my shoes makes causes irritation. CPAP and raising my bed about 6" keeps it from bothering me at night.

The endoscopy report says " There were mucosal changes suspicious for short-segment Barrett's esophagus present in the lower third of the esophagus." it went on to say "There was deformity from scarring probably from acid reflux." (The biopsy said I do not have Barretts, but the surgeon said it could become Barretts without the surgery.) The upper GI report said "Several episodes of spontaneous gastroesophageal reflux were observed, with contrast material reaching the upper esophagus." The surgeon said it is not likely to get any better without the surgery. Truth is, I am tired of not being able to do much of anything more strenuous than sitting around getting fat. If they can get it scheduled before the end of the month we have insurance that will pay 100% of the cost.

If you're taking 40mg Protonix twice a day, 30-60 minutes before meals, and you're still having significant heartburn symptoms that are affecting your quality of life, one thing to consider is a 48-hour pH test, both off and on Protonix. If the pH test shows continued reflux on Protonix twice daily, and these symptoms are affecting your quality of life, then surgery may be indicated.

If you have an endoscopy where the gastroenterologist says the findings were suspicious for Barrett's, but the biopsies don't show "intestinal metaplasia", then you don't have Barrett's. It is reasonable for the gastroenterologist to perform another endoscopy in that situation to obtain more biopsies, in case of sampling error. If the 2nd upper endoscopy's biopsies show no evidence of intestinal metaplasia, then you don't have Barrett's.

There is no evidence that a Nissen Fundoplication provides any benefit for Barrett's. It does not decrease the amount of Barrett's a person has, it doesn't decrease the risk of progression to cancer if you have Barrett's, and, contrary to what you'd think, there is no data to suggest it decreases the likelihood of getting Barrett's if you don't have it.

The reasons to do this surgery are: (1) If someone has documented acid reflux, which is improved with proton pump inhibitors, who do not want to take PPIs long-term. However, the data shows that a significant percentage of patients who have the surgery eventually end up back on PPIs, (2) If someone has documented acid reflux or regurgitation that is not improved with high dose PPI therapy.

You want to make sure that your symptoms are truly from acid reflux. The raspy voice may not be from acid reflux. So you want to make sure you document true acid reflux using a test like the 48 hour pH Bravo probe study, while on high dose PPI therapy.

[mars]

There is no evidence that a Nissen Fundoplication provides any benefit for Barrett's. It does not decrease the amount of Barrett's a person has, it doesn't decrease the risk of progression to cancer if you have Barrett's, and, contrary to what you'd think, there is no data to suggest it decreases the likelihood of getting Barrett's if you don't have it.

Hi SU

I would have thought that as acid reflux was the likely cause of Barretts Esophagus in the first place, a lessening of acid reflux, by any method, would be a reasonable precaution to take.

cheers

Mars

[SleepingUgly]

[quote="mars]I would have thought that as acid reflux was the likely cause of Barretts Esophagus in the first place, a lessening of acid reflux, by any method, would be a reasonable precaution to take.[/quote]

Yes, one would think so, but the data doesn't support it thus far.