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Re: Post Nissen fundoplication complications
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Re: Post Nissen fundoplication complications

Posted By HFHSM.D.-rf on August 07, 1998 at 06:53:41:

In Reply to: Post Nissen fundoplication complications posted by twiskers on August 04, 1998 at 20:36:29:






I am interested in any information or discussion regarding the
post-op complications of fundoplication. I underwent the surgery
six months ago, for severe reflux with pulmonary symptoms. I have
had some major problems with gas/bloat and chest pains, and chronic
diarrhea. I have experienced nausea,stomach distention and overall
feeling pretty bad at times. If there are any other patients that
have experienced the same or similar symptoms, I would love some
information and ways to deal with the "everyday" hassles. Thanks
in advance for your comments or suggestions.
__


Dear Twiskers,
Fundoplication is an effective therapy for reflux symptoms but can be associated with its own unique medical problems.  The complaints that you describe in your letter have been mentioned in many other e-mails to our Forum.
The surgeon performing the operation is faced with a difficult dilemna.  He knows before starting the procedure that if the wrap is too loose, then the reflux symptoms will persist after the operation, which will result in an unhappy patient.  Conversely, if the wrap is too tight, symptoms of gas, bloating, and inability to belch will be major problems.  For each case, therefore, the surgeon makes a mental trade-off between these outcomes.  Experienced surgeons, can usually know the tightness of the wrap based on factors such as body size and preop gas symptoms but this decision is often more a reflection of the art of surgery than the science.
In discussions with surgeons performing the operation, several general themes were repeated.  1) It is necessary to obtain an esophageal motility study prior to surgery to confirm that the patient does not have a motility disorder.  If there is a problem with esophageal motor activity and the barrier between stomach and esopahgus is surgically tightened, then patients may have post operative problems of chest pain and dysphagia (difficulty swallowing. 2) Patients who have preoperative problems with gas and bloating should have a gastric emptying study performed to confirm that they do not have gastric dysnotility.  Gastric dysmotility could cause more severe gas/bloat in the postop period.  Sometimes. surgery to enhabce gastric emptying (pyloroplasty) is done with a fundoplication in patients who have gastric dysmotility 3) Vagal nerve damage secondary to the surgery is an unusual complication but it can occur.  Damage to the vagus nerve can impair gastric motility, exacerbating the postoperative problems.  
4)It is important to emphasize preoperatively the types of problems that can develop after the surgery.  5) Sometimes, a wrap must be redone because it is too loose or tight.  This may not be the result of technical issues but merely reflect the surgeons preoperative weighing of the factors regarding the tightness of the fundoplication.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-rf
*keywords: esophagus, esopahgeal reflux, fundoplication
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