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Reflux surgery again?
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Reflux surgery again?

I had the lap nissen done about 3 mos. ago and am still having reflux symptoms, and no medicine seems to help at night.  My doctor wants me to have a PH study and have the surgery done again!!
I am very worried about this,  as my surgeon told me he wrapped it tight enough,  and if it were any tighter I would have problems the other way.  I want to know,  what kinds of problems would I have?  Lifelong?   If there is anyone else who has had to have their surgery redone because it wasn't tight enough  I would like to hear from you , and if you found relief, and/ or had other problems.  Thankyou
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Dear Carol,
Repeating the pH study would provide information whether acid reflux is the cause for your symptoms or if other possible causes should be sought.  IF the problem is acid, then you and your doctor should discuss the spectrum of therapeutic options.

This information is presented fopr educational purposes.  ASk specific questions to your personal physician.
31 Comments
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Avatar_n_tn
Hi,
I am on my second redo nissen.  Make sure you have a qualified surgeon that has done the
procedure many times.  I had the same surgeon do the second surgery .  The first surgery
lasted 4 months and the second even shorter.  My 3rd surgery will be done by a surgeon who
has done hundreds of these surgeries.  Have the ph study done.
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Avatar_n_tn
I have had a lap nissen also. It was too tight and had to have a dilatation of the esophagas. I also had problems with reflux I thought. They finally did a gastric emptying study and found a slow stomach. The PH study is a good idea.  They need to find out the reason for the reflux though.  The reason for my reflux was the slow stomach, I was backing up. I have found some relief from the promotility meds, esp reglan. Good Luck
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I had the surgery done in Feb. 1995.  I had swallowing difficulty for about six months and to this day it is still not possible for me to vomit, so I think that things were wrapped very tight during my surgery.  However I still have considerable heartburn and have to sleep semi-upright and watch my diet.  I also have no risk factors.  I'm only 25, very thin, and I don't smoke.  It's my opinion that a tight wrap doesn't always prevent reflux.  I am however very happy with the outcome of my surgery, my reflux is 10 times better than it was before.  I guess some things just can't be totally corrected.
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Avatar_n_tn
Hi Carol:

I had the nissen done, and then had to have 2 take downs because it was done too tight. Bottom line, is that you can have irreversable damage like I had, and now I suffer much worse and in many different ways. If you want to e-mail me, I can go into further detail. ***@****.

Carol
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Avatar_n_tn
Hi,

How long was the lap nissen surgery. How long was the recovery?

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Avatar_n_tn
To Chris:
  The lap nissen surgery was approximately 1 and a half hours,
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Avatar_n_tn
To Chris again
(this didnt show up)
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Avatar_n_tn
This has nothing to do with the reflux surgery.   I simply want to know if this site is out of business??  I just discovered it recently and now there is no access and no new input.  What's happening?
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Avatar_n_tn
I have had the nissin procedure almost 10 years ago. Things went well for several years but two years ago my condition has worsened. I have gone through adhesions removal but the problem is that my bile reflux has been getting worst.

With regards to the nissin prodedure, after several endoscopys, my doctors sat that it is still intact. I just don't know. I am confused too. Good luck.
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Avatar_n_tn
To: Bhagwan
  Do you have a lot of tension and stress in your life,  like I do? I am wondering how much of this could be a contibuting factor.  My symptoms are esp. worse lying down at night.
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Avatar_n_tn
A lot of doctors do no know this, but a small percentage of patients with reflux symptoms do not have acid at all (or very little), but the problem is actually alkaline bile reflux from the duodeum or small intestine into the stomach.  The symptoms are the same.  Acid and alkaline are opposite substances.  He or she might have done the wrong surgery - or maybe you needed both -yet I do not know about the surgery for alkaline reflux - I am asking that question myself.
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Avatar_n_tn
Angela,
  I was tested previously to my surgery,  with the 24 hr. PH moniter test ,which showed significant acid reflux.  I have not had another of those tests, however, as they are pretty nasty. Can alkaline reflux cause an intense sour taste in your mouth, plus gastritis and esophagitis?  I guess I would have to ask my MD about that.
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Avatar_n_tn
Yes, it can cause all of those things.  You could have both conditions.  I went to 2 major institutions who said I was normal because I passed the PH test and other tests.  A local doctor diagnosed it.  It can be seen on Xray. It hurts a lot because alkaline if the opposite of acid and stomachs are acidic environments.  I took Crafate, Propulsid 10mg, and Urso, and it
only helped about 30%.  I now take Librax, which is better, but
makes be sleepy.  The doctor said it is not stress and not
emotional.  You have to take medicine forever.  The only surgery he was aware of was very involved and not worth it - worse than
the disease.  I am trying to find out if anyone can fix it
laproscopically.
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Avatar_n_tn
i had the surgery done about 18 months ago and i have had alot of problems since. i have lost 45 lbs, scared to eat because of stomach pains. i have been through every test possible and now the doctor is thinking ibs, but i am not so sure. i am thinking it has something to do with the wrap. anone having problems with their wrap please let me know.
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Avatar_n_tn
Yikes!  Seeing all of the responses has kind of scared me.  I have been advised to have a laparoscopic hiatal hernia repair.  I am currently on Prilosec and Propulsid, which work for me most of the time.  I still have symptoms, but less so since starting the meds.  The doc says I will have to stay on them for life or have the surgery.  I am concerned about being on medications for life (what about side effects?), but I am also concerned about the surgery long-term.  From the responses I have read here, it sounds as if people continue to have problems or at least different problems.  Maybe it would be better to just live with what I have.  The only problem with that is that I'm fearful of developing Barretts, which I believe is a pre-malignant condition.  So what are the real choices??  Also, since I have had a prior cholecystectomy (gallbladder removal the old-fashioned way), I was told it was possible I would not be able to have the hiatal hernia repair done laparoscopically, but would end up having major abdominal surgery.  Yikes!!

My questions are these:
1.If I just try to live with the situation the way it is now and stay on drugs like Prilosec and Propulsid for life, what is the danger of developing Barretts??  

2.  If a person develops Barretts, what percentage of those      people go on to develop esophageal cancer?

3.Are there side effects to long-term Prilosec & Propulsid use?

Any help would be appreciated....Thanks, Cathy

4.
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Avatar_n_tn
hello my name is rocky im new at this so bare with me. ive been giagnosed with barrette esophagus non cancerous, my doctor was going to give me a lap nissen after an esophonomentry. after the esophonomentry he told me I had passed but I didnt need surgery right now that he would just scope me once a year and up my meds.
What gives cant this turn into cancer, isnt ther a treatment?
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Avatar_n_tn
i had my surgery march of 99 the only problems i had was the first 6 weeks i had a real hard time swallowing almost anything that wasnt liquid but slowly it went away, prior to my surgery i had been on every medication that was available prilosec worked for awhile then stopped my only hope was the surgery and i have to say so far its been the best thing ive ever done, they also removed my gallbladder and that has been the nightmare!!!!  good luck to everyone and be sure the surgeon you choose has done this precidure alot.... that can make a big difference....
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Avatar_n_tn
i too am starting the process for laproscopic surgery for hiatal hernia and the valve in the esoph. that doesnt close to hold down food and acid etc.. the doctor has done this surg. 60 or so times..at least one evey othe week. i havent found a way to check on him or his credentials. i am so worried that i will have more trouble after the surgery. prilosec does not help any more and i have severe pain in chest(mostly left side) and upper stomach right below rib cage. i get irregular heart beats and headaches all the time. could this be associated with the vagus nerve? i have tried to research this area but dont understand all the medical terms.i would appreciat any helpful advice, i am relly at a loss for what to do next. surgeon and gastro. docs say surgery is the only relief.
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Avatar_n_tn
I had the lap Nissen in May '99. By Sept. '98 I had developed in incomplete wrap.  The stomach wrap had gone up through my hiatal hernia into my chest.  The first proceesure took 4 hours and left me with enough pain that I was in the hospital 6 days instead of he planned 2.  The Hiatal hernnia repair and Cassell wrap (1/2 wrap)surgery was also done as a lap.  I had both the original surgeon as well as a new surgeon working on me for 9 hours.  I have the distinction of being the longest lap case at that hospital for 1998.  I was fortunate to have a Dr. that had completed a fellowship in lap proceedures at Cedars Siani.  I did very well with the 2nd surgery.  I waq back to work part-time 3 weeks after a 8-day hosptial stay.  

Around 4-5 months after the 2nd surgtery I started having pressure and gas pain.  Dr. suspected gastritis.  I was on and off Zantac and Prilosec for about 3 months.  After attemped to control the reflux that returned with Zantax twice a day (plus needed a chewable otc Pepcid AC at night)I am back on Prilosec at night.  This seems to control symptoms.  Since I went from pressure/gas pain to reflux I suspect that the hiatal hernia has pushed itself open again.  A baruim swallow showed that the wrap is complete.  However, Dr. says I have an unusual case and that might be what happended.  

I apologize for such a long message.  I feel that the 2nd proceedure was worth the trouble.  However, had I found this site before the 1st surgery I might have made a different decision.  At the time I thought that I would be able to relieve pain and symptoms I had experienced for 17 years and no longer need medication.  Anyone who would like to respond can email me at ***@****.

Thanks,

Toni O
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Avatar_n_tn
Ooops.  That first surgery was October '97.  See what happens when you are on the internet past you're bed time.
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I give up.  May'97 will actually make more sense.
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I give up.  May'97 will actually make more sense.
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I have also had many complications from the lap nissen.  And I still take a maximum dose of prevacid daily since developing duodenal ulcers post surgery.  I had the surgery 1 year ago and continue to have problems.  Consider this procedure carefully, since it is neither simple, nor a complete cure for reflux disease
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My 11 year old son had his first Nissen (not a lap - not available then) when he was just 3.  That wrap was too tight and was dilated which made it too loose.  He required a redo about a year later.  This one had further complications with an internal staple making a hole through from the stomach to the esophagus thus giving him another orifice to reflux through.  He then had a third fundoplication 10 months later and had a G-tube placed at this time since he couldn't eat enough to sustain himself.  The 2nd and 3rd surgeries were done by the same surgeon.  After the third surgery, he never did very well.  He needed a fourth surgery which along with the others left him with a very tiny stomach.  He also had pyloroplasty with the second surgery which allows his stomach to empty quickly.  His motility is not normal and he is left with dumping syndrome and the inability to vomit.  He suffers tremendously.  However, the dumping syndrome is fairly easy to treat if you find the right doctor (which we have) who specializes in motility disorders though we have to travel a considerable distance (6 hrs) to see him.  I thank the Lord every day for him because without him and the surgeon who did the 4th surgery I don't know where we would be.  My son does still have some reflux symptoms though they are mild in comparison.  Make sure you do thorough research on the physicians before you have anything done and make sure that any testing that may be necessary including pH probe, endoscopy, upper GI, esophageal manometry, and gastric emptying scans are done prior to any surgery.  It could make all the difference in the world.  

Sorry this message is so long, but so have the past 11 years been long.
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I too had the Nissan last June '99.  I had my hiatal hernia repaired along with the flap.  This was done by lap.  For the first 3 months I could only swallow liquids.  After that I advanced to soda crackers, yogurt, cheese, etc.  Anything soft and that could melt in my mouth.  I still have problems with swallowing.  Gets stuck in the area of the hernia repair.  The followup endos showed that my wrap was just right, not too tight.  My surgeon said that I most likely have a problem with swallowing that will remain for life, if I can tolerate it.  Otherwise, he said that I can go back in and have the hernia undone.  I opted for the later, thank you.  I have problems with this swallowing daily.  I also have Barrett's esophagus.  Yes, this can turn cancerous.  It needs to be watched carefully.  My surgeon said that to have that repaired to cause a MAJOR change in my life.  I did alot of research on this.  Not nice - regarding the surgery.  There is not enough room allowed, I suppose, to go into this here.  My advise for anyone who has Barrett's is to go online like I did and research it.  It takes alot of patience but it is worth it.
   If anyone wants to email me about this my email is:  ***@****.
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I have had 2 surgerys and I don't have heart burn but my belly goes from a 23" to a 38" by night and thats only eating 1 time a day. Has anyone had this and what did they do. I dont want to eat. Before my last surgery I lost 39# and I can not lose any more. I got down to 90 # anyone have any help?
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I have had 2 surgerys and I don't have heart burn but my belly goes from a 23" to a 38" by night and thats only eating 1 time a day. Has anyone had this and what did they do. I dont want to eat. Before my last surgery I lost 39# and I can not lose any more. I got down to 90 # anyone have any help?
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Avatar_n_tn
I have suffered with heartburn and refulx for about 4 years now.  Have consulted a laproscopic surgeon who did the various tests.  The one test I could not do was the manometry test.  There was no ways I could swallow that tube while being awake!  My surgeon says all my symptoms will dissapear after having the surgery.  After reading these comments above I really am quite wary of having the surgery now!  I am 33 and am on controloc for the heartburn and prepulsid which I take every other day.

Is there anyone who has had the surgery done without having to have that terrible mannomety test (it tests acid build up?  Can the procedure still be perfomred correctly without having the results of this test.  Is there perhaps a Doctor or someone qualified to answer this question for me.  My surgeon seems to think it can still be done but obviously he would prefer me to have the test done but this is really quite impossible I have tried twice to do it with sedatives etc., but get really scared when asked to swallow the tube!!!

Please contact me at ***@**** if you could offer any light on the situation for me and any advice.  Thanking you.
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I had recently undergone my first laproscipic nissen fundoplication 11 weeks ago.  Since that time I have had problems with severe esophageal spasms(spreading to my jaw, neck and entire chest) and vomiting (at least once a day) with meals.  I have tried nifedipide and reglan without much success.  I have been dilated twice which proved very benificial but ONLY for a day or so following the procedure, then I am right back to normal.  I have been given several opinions ranging from :1 - continue to wait it out and 2 - have the wrap revised to a partial wrap which is more easly tolerated.
I was hoping to hear from someone who underwent a similar scenario, find out what they did and how it worked.
I would really appreciate your input so please add it here!!!!!
Thanks,
Russ
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Avatar_n_tn
I had recently undergone my first laproscipic nissen fundoplication 11 weeks ago.  Since that time I have had problems with severe esophageal spasms(spreading to my jaw, neck and entire chest) and vomiting (at least once a day) with meals.  I have tried nifedipide and reglan without much success.  I have been dilated twice which proved very benificial but ONLY for a day or so following the procedure, then I am right back to normal.  I have been given several opinions ranging from :1 - continue to wait it out and 2 - have the wrap revised to a partial wrap which is more easly tolerated.
I was hoping to hear from someone who underwent a similar scenario, find out what they did and how it worked.
I would really appreciate your input so please add it here!!!!!
Thanks,
Russ
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Avatar_n_tn
I have just started looking on the net for some additional info
on having your esophagus replaced with the small intestine.  My
mother of 67 years of age has had a swallowing problem for about
37 years and only about seven years ago started to get her throat
dialated, two or three times a year.  Although this helped for
a period of three or four months the doctor she goes to expressed
that he did not think he could go on doing the dilatation because
of the risk of tearing through the esophagus wall and that would
mean major, major surgery!  He also said that we should start
to think about possibly removing the esophagus and replacing it
with the small intestine which would mean breaking the breast-
bone and six-weeks to six-months recovery, that is if everything
went well.  My mother has no idea how she got what she has.  Her
esophagus is 7 to 8 inches in length and strictchers down in
random places throughout the esophagus to less than a pin size
opening.  The procedure she has done each time to stretch her
esophagus in only temporary and a major risk is taken each time
she has it dilated.  My Family and I need help in searching out
all of our available options. If anyone out there can give some
input please contact me at--***@****

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