Fundoplication: revision

[Smiley2000]

Hi there,

I am normally a Community Leader here, but today I am a patient, looking for information, support and advice.

During Feb 2012 I had a Nissen Fundoplication (partial) done for severe reflux.  Prior to the Fundoplication, I was diagnosed with having a long segment of Barret's Oesophagus and suffered from chronic bronchitis.  I agreed to the surgery and soon felt the benefits from it.  I had a follow-up Gastroscopy during April that year and all was well.

For the past 6 years however, I struggled with chronic throat infections and a lump in the throat and occasional chest pains.  That, unfortunately never improved after the surgery and I consulted a Otolaryngologist/ENT Surgeon who did a Esophagoscopy and diagnosed me with Chricopharengeal muscle dysfunction and I was treated with Dilatation of the oesophagus and botillium injections.  To date I've had 4 botillium treatments.

Recently, we moved interstate and I was referred to a new ENT Surgeon.  My previous Surgeon was of the opinion that I would benefit from a Myotomy, to fix Chrico issues.  My symptoms:  food does not pass down into my stomach like it should.  It backs up into my chest.  I get terrible spasms - jaw, throat, chest and radiates into back. The new ENT Surgeon was not convinced that the diagnoses and treatment plan is the best for me, so he ordered a few of his own tests...

2 weeks ago I had a Gastroscopy through a Gastro Ent and I have redness from acid reflux and was again instructed to take PPI's for it.  Yesterday, I had a Manomatry and 24hr PH study.  The result from the Manomatry:  my LES (lower valve) does not relax and therefor my food can not enter the oesophagus, the way it should!

According to the Doc that did the Manomatry, I need a revision of my Fundoplication!  that came as a shock to me!

I'll see the ENT Surgeon again in 2 weeks, but in the meantime I would like to hear your thoughts!  

[Smiley2000]

Thanks Selma,

Yip, that is about what I also got.  That it is very rarely used and more expensive than the conventional one, but very accurate because of the spacing of the sensors.

I get frustrated by all of these horrible tests, but I am glad that the Surgeon is not trigger happy and wants to make absolutely sure before he goes ahead and do something...

I'll go on the 23rd of September.  Will let you know what the findings are.

[selmaS]

  Hi...I am not aware of what that is either...so in looking it up I found this -
" For a manometry system to be classified as "high-resolution" as opposed to "conventional", the pressure sensors need to be spaced at most 1 cm apart." Source :https://en.wikipedia.org/wiki/High_resolution_manometry

Good luck

[Smiley2000]

Hi there,

Just an update:  I had a consult with a GI Surgeon and he said that he will do me more harm than good if he does a revision of the Fundoplication. He is sending me for a high resolution Manomatry! Have never heard of it but he wants to make double sure of the LES function.

He also said that he can do a stretch of the entrance to the stomach - where the LES is. A lot less invasive than surgery!

I'll keep you posted...

[Smiley2000]

Hi there,

I am so sorry to hear about the troubles you've been having. I can not even imagine what you are going through!  I pray that the Doctors find a solution for you and don't give up until you are satisfied that they are solving your problem and not adding to it.

Please keep me posted.

All the best,

[Anngal]

I am trying to get my full Nissen fundoplication undone because I've been throwing up since it was done over 5 months ago as part of hiatal hernia repair. I wasn't overweight to begin, 5'6'' and 128 pounds, and now I'm under 100 pounds because I can't eat more than a few bites before it comes up. a pre-op mannometry showed normal esophagus, but a recent upper GI showed that my lower esophagus balloons out and that's where most of my food sits instead of going into my stomach. Some food does get into my stomach via a slow drip from my esophagus, but 2 dilitations failed to correct the problem. My surgeon thinks I need another dilitation with a bougie? (stiff piece of plastic) inserted to hold my stomach open. I've had all the other complications: intense gas, gastroparesis (finally resolved) and awful bouts of throwing up with diarrhea once every 1-2 weeks that I originally mistook for food poisoning or virus until I researched vagal nerve problems. Nausea and loss of esophageal tone are both listed as vagus nerve damage indicators. It seems to me that if my stomach wrap is pressing on the nerve from the outside, the last thing I need is a hard piece of plastic pressing on it from the inside. So I'm going to another surgeon in hopes he'll undo the wrap without another dilitation. Quality of life is terrible with pain and heart pounding whenever I eat or drinik, over half my waking hours spent eating or at the sink throwing up, no energy, 2-3 naps per day, and still losing a couple more pounds every week even with Ensure and other high calorie supplements. Bottom line: I traded a molehill of problems (hiatal hernia pain with minor reflux) for a mountain the size of Everest, and I want the molehill back.

[Smiley2000]

Hi there,

How did it go? Please come back and tell us about your experience with a revision Fundoplication.

All the best and a speedy recovery.

[Smiley2000]

Thanks Selma,

One thing in life that I've learned, is that Doctors are people and people make mistakes. We have to empower ourselves with knowledge and be prepared to learn every day.

I'll keep you updated on the developments.

Take care,

[selmaS]

  Hi...thanks for the update and sharing your journey with these issues....I am sure they will help someone else......

  It is sad that we must investigate so much about health care....we all must be our own advocates.

  

[Smiley2000]

I see all my regular friends are busy... hope this message finds you well.

I am learning a lot about revision of Fundoplications by google and it is shocking!  I'll find out on Wednesday what my ENT Surgeon thinks, but I am just so thankful that I did not allow the previous doctor to do a Myotomy!  I think I was misdiagnosed with having Chricopharengeal muscle dysfunction and all my symptoms are due to a stenotic/tight Nissen wrap :(

I hope my story, once again, help other people.

[Smiley2000]

All the best for your procedure tomorrow!  I would like to chat with you afterwards, when you are feeling up to it.

[Cariad12000]

I'm having my Fundoplication reversed tomorrow. The side effects of the  operation are greater than the original problem so the reversal can't come fast enough.
I never felt any reflux but apparently it showed up following investigations for something else. Since the operation I struggle to swallow anything bigger than a large pea. If I do the food becomes lodged in my throat and I get severe pain and have to regurgitate the blockage. This happens several times a week and sometimes several times a day. I've been hositalised twice when the bolus got stuck and had to be removed via endoscopy.I have had a number of stretches  but they were unsuccessful. I won't mention the diarrhea and the bowel side effects!

I just hope the reversal will allow me to live a normal life again.

[Smiley2000]

Hi dear mate,

You are the expert on this one...