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Reflux back after 4 weeks Post Op of Nissen Fundoplication Surgery
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Reflux back after 4 weeks Post Op of Nissen Fundoplication Surgery

Is it possible for Reflux to return in 4 weeks following a full wrap Nissen Fundoplication? I understand not all people can get relief from surgery, but 4 weeks!
I'm a 47 year old male and I've had GERD for 14 years. Finally, after running the gambit of meds, which only lasted 6 months to a year before they stopped working, my Gastroenterologist sent me to a surgeon. I had the Motility study(which was normal), the esophagus mammetry(which came back normal) and 24 PH monitor test(which I suffered through!). The results showed I had Severe Reflux. The number(the name of the test or scale eludes me) showed I had a score of 34 where normal people have a 12 or 14. I've seen more Cardio Doctors who have told me my heart is fine so it isn't my heart.
My questions is, is it possible for the Reflux to come back after only 4 weeks. The 1st 4 weeks were great! I loved it! No Reflux and my scars are all but healed!  But, on my 4th week I had 1 episode of Reflux. Then another 2 days later, then more on each day after that plus night time attacks too, which woke me up as it did before.  I can not burp presently, which the Doctor told me will happen, and still have trouble swallowing breads and of all thing chicken! But meats are fine, salads, fruits, etc are fine.  
I started back on Protonix at twice a day 2 days ago. Plus, Mylanta to combat my attacks that do not go away.
Does the Nissen Fundoplication work for everyone, regardless of how severe the GERD is? Or, as the severity of the GERD increases the chances of the Nissen Fundoplication working decreases? I mean, I'm still having trouble swallowing certain foods which tells me the wrap is working, somewhat. But then, how come I'm having the same old Reflux problems again!
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There are a proportion of patients that require medication after a fundoplication.  Some small studies estimate that up to 60 percent may require a PPI after surgery.  

There is also the possibility that the fundoplication may not work - however, in general this is an effective modality for GERD.

You can discuss with your physician contining on long-term PPI therapy, or consider testing (i.e. an endoscopy and/or 24-hr pH study) to determine the severity of the GERD.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com
12 Comments
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Did your manometry test show that the Lower Esophageal Sphincter pressure was low?  You said that everything looked normal; it seems like if the LES pressure wasn't a problem in the first place that reflux is caused by something other than a weak LES, in which case it seems like surgery might not be all that effective.

Also, have you been checked for an infection like H Pylori in your lower esophagus?  If you have inflammation in your LES I'd imagine it couldn't close tight enough to keep acid fumes out.
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That test came back normal, as far as I can remember.  Did the Doctor actually measure the LES muscle itself? I don't know? I do know I watched the tube being pushed in to my nose and down my throat, which...if you've had the same thing done, it was rather uncomfortable. Right after the test the Doctor inserted the 24 hour Ph monitor test probe.
I had the Gastric empty scan too, which said normal also. I've been on every med so far, with Nexium twice a day being my last type before the surgery.
The only thing is there is NOT one food I know of that causes my GERd every time? Oh, I would get it maybe from eating Pizza, that one time. But, I would not have GERD from eating Pizza the 10 times before the episode or the 10 times after the episode? This is how it's been. The foods that they say cause an attack might bring one on for me in 1 out of 20 times, but not every time.
Last night, 8/23, I still had problems swallowing meat and some potato's which told me the wrap is still in place. But, 6 1/2 hours after dinner I woke up from a sound sleep from an Attack, AGAIN! I just don't get it?
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I suggest you get an xray done on your spine.  I have read and confirmed my idea about the spine and acid reflux.  A Chiropractic can make adjustments to the spine.  Also you can do some back exercises.  I do a few and it relieves my back pain and acid reflux but it takes times.  Up to 2 to 6 months for total relief.
Also I suggest you get some antiparasite pills they can cause gas in your stomache also.
Eating foods high in PH and eating less foods with low in PH is known to be effective.  Basically eating LIVE foods like vegetables and fruits in moderation.  You can take coral calcium or calcium carbonate which is known to have a  PH level of around 11.  Your blood or salva PH is suppose to be around 7 to 7.5.  You can buy PH strips at health food stores.
I would avoid heavy lifting or intense exercise unless you wear a back brace for your back.  That is how mine got worse when I started to weight lift.
Most imporant never drink ANY carbonated drinks especially pop.  It is very acidic (PH around 3 to 5).  Also buy a juicer and start juicing vegetables.  This is better than any pill.  Juices are more easily absorbed by the intensine.
You you may want to consume flax seed oil and pysillum husk power when you have your acid reflux under control.  This is to clean out the colon.  You will want to juice and eat a  lot of vegetables.
YOu might also want to get some Miso (aka soy bean paste).  It is fermented soy beans.  Probably best to use it in a salad since it is very salty or eat kimchi which is fermented cabbage from a korean food store they can be pretty spicy so if you like the taste but can't handle the spiceness you can ask if they can start making less spicy version.  This is only done if you have it under control.  You can also get LIVE bacteria cultured yogurt.  Not the low fat one just plain version that states live culture.  The more sour/bitter tasting it is the bettter.  There is bacteria everywhere.  Water food etc.  YOu can not avoid no matter what you do in fact bacteria thrives.  I know this because my best friend is an expert on water.  He said the only way to completely get rid of bacteria in water is to boil in very high temperatures which we can not do.  You see fermented foods has friendly bacteria which will fight off these invaders.  Usually the stomache acids kills them but not always.  I remember when I used to eat kimchi all the the time I hardly got sick and when I did catch a cold it was gone less than half the time than others.  
I never caught the flu til  I started slow down eating kimchi so I suggest you consume fermented food just for health reasons.

Also if you have allergies you need to get them under control if they are acting up lately.

Good luck I hope this works for you.
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I must add that it is important to make sure a systemic yeast infection is under control before doing juice fasts. The sugar from the fruit feeds the yeast and/or parasites. We all have parasites whether detected on a test or not. As Mike stated, this type of healing takes time and committment. I am a huge fan of chiropractic. My entire family goes, and my 4 children have not had to see a medical doctor for an illness in over 4 years.
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I also had Nissen Fundoplasty 17 mos ago. Never have I had any relief from symptoms, have had all mentioned tests, 24 hr ph, manometry and endoscope. Shortly after surgery, 2-3 weeks is when the hell began. I had 5 mos of almost straight nausea and no relief from Acid reflux, and I also suspected that was not the cause. I had some relief for a very short while after 3 dilations of esophagus. Now again the same is acting up and no telling what sets off the heartburn and nausea. Just had the 4th endoscope and colonoscopy and surprise everything appears normal. Now it seems as if we have the same problems to an extent, with different variations. I am down to eating almost nothing having lost 10-12 lbs. in a 2.5 week stretch. There has got to be a better answer. I have not been able to work since this and I am getting so frustrated the docs can't poss imagine what its like and are beginning to think it's all in head. Having had 3 children and morning all day sickness with all, it is almost worse that that. I sincerely hope that there are answers to be found.
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Anyone with acid reflux needs to stop all vitamins unless the doctor tells you it's necessary.  I have severe acid reflux.  You must cut out all POP, wheats etc.  I strong suggest juicing fresh vegetables.  Cut out all meat, nuts, rice, all processed foods.
You wonder what you're suppose to eat.  Until the problem is gone, you should consume fermented food.  Some people cultured live yogurt works.  Ripe bananas are excellent, they don't need to be black but ripe enough that the friendly bacteria grows.  Another way is to get cabbage and ferment it.  It is not suggested to eat them not fermented because they will cause gas.  Brocolli is another gas causing vegetables.  No fruits except bananas because they ferment during the ripening process.  POP is pure poision and will eat your stomache.  What you need to do is get PH test strips.  

There are ones for silva or urine.  silva is suppose to be around 7 but it can be incurate if you have stress but stress contributes to the acidicty of your stomache.  Stomache acid blockers will not eventually work and most acid reflux meds will make your system worse.

Drinking reversi osmosis water that has a ph level around 7 is good.  Best to drink the water warm or hot.  Cold water is not good for the body so advoid anything extremely cold.

Oh I forgot try not to consume any fats even olive oil.  Flax seed oil isn't good either.  Get the actual seed to consume apparently the flax seed oil causes people to throw up.

No species, no vinegar.  Milk can be soothing if you don't have lactose interolant.  Orangic milk because you don't want to pump **** into your body.

Foods I can eat is cukes (with celtic sea salt, aka unrefined seasalt), lettuce, (chinese cabbage, napa can be eatened on fermented but simply adding salt and let it sit there overnight with water then the next day simply drain the water and let the cabbage sit there up to a week at least 3 days though)celery, carrots, and ripe bananas.  I avoid all meats, fish, seafood.  I recently posted but I had to change a few things.  You can try miso (fermented soy bean paste)  in salad if it doesn't give you gas.

It's absolutely crazy to get surgery.  The reason is the stomache is still very acidic.  It's like putting a glass of coke in a small bottle and adding more acidic coke into it.  It will just get worse in time or stay the same.  The only way is to nuetralize the acid.
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Help, I am looking down the nose of a Nissen and am scared to death.  No one seems to be able to tell me exactly what to expect after surgery.  Will there be a NG tube, is the cath still in, will I be able to motivate.  Some say 1 days stay in hospital others say 4.  Any help is appreciated.
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I had the surgery done last Oct. will make a year. The Doctor is a BIG part of having it done right. Mine has done over 500 of these and is one of the best. Here is a web sight that I found right before I had mine and it help me a lot to see this. Good luck, Karen
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I had the surgery done last Oct. will make a year. The Doctor is a BIG part of having it done right. Mine has done over 500 of these and is one of the best. Here is a web sight that I found right before I had mine and it help me a lot to see this. Good luck, Karen    
http://www.or-live.com/umm/1202/
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I don't know why that web sight pop up on my comment above so sorry about that.I don't even know what that is!!  I'll try it again.
(University of Maryland)LIVE WEBCAST Gastroesophageal Reflux Disease (GERD)
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One of you had asked for information from people who had had this operation.  I had my Laparoscopic Nissen Fundoplication last Friday, September 9, 2005, to correct a hiatal hernia that was causing a bleeding ulcer.  Due to the resulting blood loss, I had become severely anemic, requiring multiple blood transfusions.  I remember being wheeled into the OR at 1pm and being helped into bed at 6pm, but nothing in between due to the Versed that had been administered, so I can't say how long the actual procedure lasted.  My guess is about 2 hours.

Back in my room, I was still being given IV fluids plus morphine pushed into the IV for pain when requested.  (I received about 3 shots total, but don't know the quantity.)  I was allowed to get out of bed with help to go to the bathroom to urinate, which occurred about every 2.5 hours due to the constant IV fluids.  Had I been a guy, I'm assuming that I'd have just been given a urinal to use . . . but maybe not.  They may have just been seeing how well I tolerated getting in and out of bed and walking for a short space.

When asked about my level of pain, I said 6-7.  To tell you the truth, I've never had surgery or experience any major pain, so I had nothing on which to base my answer other than one of the nurses suggested using a level 4 to identify a routine headache.  With a level 10, I figured that I'd be writhing on the floor, so a 6-7 seemed to be a fair answer.  I was in pain, yes, but it wasn't excruciating.

The pain I was experiencing was around the five incisions, plus shoulder pain that was due to leftover air remaining in my body from when it was injected into my abdomen to enable the surgeon to have a better field of sight in which to perform the procedure.  I'm told that this will last up to a week.

I wasn't given anything to eat or drink the first night, but was given clear liquids (chicken broth, tea, apple juice, and jello) around noon the next day.  I didn't experience any problems swallowing or clear liquids in my stomach.

Because I tolerated my initial meal well, as well as the fact that I wasn't in too much pain and could walk on my own, I was released from the hospital Saturday afternoon, September 10th, at about 2:30pm.  I was sent home with Loritab Elixir as my discharge meds, approximately enough for one week.  It's a liquid form of Vicodin.  My dosage is 15ml every 4-6 hours for pain.  So far, I've been taking it every 4 hours due to the shoulder pain and general discomfort I feel when standing up and sitting down, as well as when I lay on my side.

My post-op diet consists of a combination of clear and full liquids, i.e.,  Jello, apple juice, cranberry juice, broth, applesauce, pudding, liquid shakes, yoghurt, yoghurt smoothies, etc.  This diet will last for 2 weeks, at which time I'll be able to add pureed foods to the list.  This diet will last an additional 2 weeks, at which time I'll be able to slowly introduce solid foods, as tolerated.  NOTE:  I haven't listed all of the do's-and-don'ts of the diet lists, rather just the highlights.

I've experienced a little bit of bloating, but nothing I couldn't tolerate.  I've tried to follow all of the post-op rules about reducing bloating:  no carbonated drinks, don't drink with a straw, don't eat anything that causes gas (i.e., cauliflower, broccoli, beans, etc.), don't eat large meals, be conscious of not swallowing air (which can be a problem with GERD sufferers).

I've been told to still keep taking Prilosec (20mg twice a day), as well as the iron supplement (365mg once a day) for at least 1-2 months until the ulcer heals.

It's only been about 72 hours since the surgery and so far, so good.  I'm taking it one day at a time.  While I did have GERD, it wasn't the primary reason for the surgery.  Resolving the bleeding ulcer was.  Had the procedure not been performed, the surgeon said that the ulcer would have perforated the stomach eventually, requiring major surgery and complications.  At this point, I'll just be happy to end the bleeding which caused my severe anemia which in turn caused shortness of breath, heart palpitations, constant fatigue, dizzyness, etc.  When I had my first transfusions at the end of April 2005, my hemoglobin was 5.8.  After 3 units of blood, it was 10.8.  However, due to blood loss between then and September 8th when I had my last blood test before surgery, my hemoglobin had fallen to 7.9.  As a result, 2 units of blood were administered during surgery.  It's something that will have to be monitored for some months to come.

Hope this helps.  My situation is somewhat different than yours, but I'm sure that my experience with the procedure itself is typical.  As someone else said, make sure that your surgeon is experienced with the technique.  I had a lot of faith in mine, as I'd been told that he's already performed 100s of the procedures and takes on the problem cases, including redoing procedures by others that had failed.

Let me know if you have other questions.

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I had a nissen October 2002. Had awesome results from it (actually woke up from surgery and told them that I felt 100% better). Unfortunately after my son was born, all of the symptoms returned but endoscopy and all other testing has shown that it all held up well. Nauseated 75% of the time, reflux every night, strange bowel habits and irritating abdominal cramping. I really do feel that the symptoms I am experiencing now have everything to do with my pregnancy. But, for the 4 monhts post-op I was in heaven. I only needed Toradol (a pumped-up Ibuprofen) for 3 days post-op, never needed the Vicodan or any antacid treatments. Now, Zantac 150 is my best friend. Just went back o the doc today, now tests for celiac disease. When will it end???
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