LAPAROSCOPIC FUNDOPLICATION

  About six years ago I underwent a series of gastric operations following complications arising from a vagotomy. The follow-up surgery included a further vagotomy and pyroplasty, a gastroenterotomy abd, very shortly afterwards, surgery to repair a consequent incisional hernia. All this surgery, entailing as it did no less than four laparotomies, has led to severe weakness in my abdominal cavity and gullet, and I was advised at the time that I may well suffer complications in the future.
  I now have a pronounced hiatal hernia and consequent, and almost permanent, biliary reflux which is not controlled by Losec (Opeprasole) or other proton pump inhibitors. A recent barium test revealed that my gullet is not contracting as it should when I swallow.
  My surgeon has now recommended a "Laparoscopic Fundiplication" (whatever that is), but has cautioned that the operation carries no guarantee of success and that it could, possibly, even make matters worse!
  From the information which I have supplied do you think that the operation proposed would carry a better than 50% chance of success?
  I should very much appreciate any advice or assistance about this very unpleasant and worrying condition.
  Thank you.
  CHRIS BALSTON
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Dear Chris Balston,
If you  have had a number of operations on your stomach, you most likely have several scars on your abdominal wall as wellas scarring on the inside.  The proposed surgery will be technically more difficult, and maybe impossible, if there is much scar tissue in the area of the proposed surgery.  
If you and your physician agree that fundoplication is to be done, then have an esophageal motility study to confirm that the esophagus is functioning properly.  You do not want to have swallowing problems as a consequence of this new surgery.  Finally, if your problem is bile reflux into the esophagus ( as opposed to acid reflux), a roux-en-y jejunostomy may relieve your proble.  Again, however, the surgery may be difficult because of the scar tissue from your previous operations.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
If you wish a second opinion, we would be happy to see you in the Division of Gastroenterology at Henry Ford Health System.  You can arrange an appoinment with Dr. Fogel, one of our experts in the treatment of gastrointestinal disease, by calling [phone].  Dr. fogel would review your records and make suggestions regarding possible next steps.
HFHSM.D.-rf
*keywords: esophageal reflux, fundoplication
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