Hiatal Hernia Surgery, GERD, Gatritis

[Aub]

I am a 55 year old male who has had problems with heart burn on and off for the last 20 years.  For the most part, I think my heart burn was usually agravated by a lot of coffee,  eating late, etc.  But I am 6' and weigh about 205 lbs.  I am active and usually don't have much stress.   About 4 months ago, I started experiencing a lot more heart burn than usual. I tried 1 tablet of OTC Prilosec and that didn't do much.  Other symptoms included a feeling like a tight neck, hoarsness, chest pains.  A digestive disease doctor did an upper endoscopy and discovered a medium sized hiatal hernia,  gastritis, some mild erosion in the esophagus- but no Barret's esophagus, (confirmed by biopsy).  I feel better after say taking a 40 mg Nexium pill for the last 5 weeks, but I did go to a surgeon who does the Nissan hiatal hernia repair and he recommended it.  He says this will cure the Hiatal Hernia and most likely I will not need any more pills. He says that after a period of time the lower LES may losen but that is usually not a problem.   In that case, the pills or diet would work easily to control heartburn.  (There is a 80 to 90 percent success rate on the surgery).  I will need a barium swallow and manametry.  What's your take on this?  Should I give it more time?  

Thank You
Aubrey Sonsini

[Kevin Pho, MD]

Whether surgery would work depends on the severity and size of the hiatal hernia.  There will always be the chance that the surgery will fail, and medications will be needed.  

If there is concern about the prognosis or treatment efficacy, I would always obtain a second surgical opinion to ensure that the proper course is being taken.  

Barium swallow and manometry are reasonable tests to further work-up your symptoms before surgery.

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.
kevinmd_b

[klpaul]

What ever you do do not get the fundo.  We have a daughter that had it due to scare tactic(cancer) and what a mistake.  Her having Cancer would have been easier that what we are expericencing now.  Every since the surgery she has had severe pain and vomitting (although she is not suppose to be able to). Her wrap is still in tact but we are told it could rip apart after the surgery.  They give the wrap only 7 to 10 year. Research testimonies and comments from patients that have had this surgery.  There is just too much to risk with this surgery.

[surgeon]

for most people with hiatal hernia, the indication for surgery is symptoms not controlled medically. It sounds as if the medication is working well, so unless you are having side effects from the pills, or for some reason get to the point where you don't want to take them, and given there's no Barrett's, it seems that having surgery is optional at best.

[Aub]

Well,  the pills are not working completely.  Even during the day I can experience some tight neck and chest discomfort and periodic hoarsness.   The manometry went very well.  It showed good pressure in the LES and good movement in the esophagus.  I guess the good news is that maybe it's just the hiatal hernia that is causing most of the symptoms.  I was not able to have the barium swallow because they give you squirts of water during the manometry test and you can't have anything for the barium swallow.  I will have that in next Friday.  But I am about 85% better with the pills.  I see the surgeon to discuss results in about 2 weeks.

[yoshi]

nexium cannot shut down all the acid in your stomach,you have to pay attention to what you eat as well.

[Aub]

I take nexeum and have changed my diet a lot by cutting back on cafe and evening snacks.   I think it is well documented that a hiatal hernia can agravate GERD.  I used to take Prilosec before I had a hiatal hernia when warranted and it worked just fine.  It would stopr the heartburn and swallowing problems fairly rapidly.  But I have a tight throat, some chest pains, even if I eat a medium sized meal slow.  My understanding of the operation is that even if it fails,  Nexeum, eating habits and style, etc. will work easily when it doens't work now.  That is, it is felt the hiatal hernia is a big culprit.

[yoshi]

sometimes the problem is not enough acid,not too much acid.
you can tell if you feel full right immediately after you eat,this is a sign of not enough acid.

[celine149]

I also am not a fan of the nissen fundoplication surgery. I do have barrett's esophagus and I had this surgery done at one of the really big well known medical universities. I had a 360 degree wrap done but it was a loose wrap. Obviously it was way too loose, as in why did I even bother. My surgeon discontinued all my PPIs (nexium) at time of surgery and said I would never need them again, even though I have barrett's...Within 1 year I was hospitilized with bleeding esophageal ulcers and my LES was wide open. It was a completely failed surgery. There are alot of people though who have had very good results with this surgery. Just make sure, if you do have it, that you get a really good surgeon, who has done alot of these type surgeries.

[Aub]

Yoshi talks about not being enough acid that causes acid reflux.  There are many naturalpathic books out there that have talked about this. But just like Kevin Trudeau and his miracle cures the drug companies and FDA doesn't want us to know about, I am skeptical.  I have good LES function so it could be the hiatal hernia that is causing the discomfort.  I have some hoarness, chest pain, and it is much less lately since I have been on the Nexeum.  I think when I sit or bend over it may sometimes start something, but not always.

[kazma]

I would like to warn you about the Hearthburn surgery. I was told by a surgeon that it would cure my herathburn. However, the surgery was unsuccesful where I developed paraesophageal hernia (which can be fatal) after the surgery. The second surgeon needed to fix the hernia and redo the fundoplication surgery. He messed my internal organs up completely. I had to be hospitalized for 8 days after the second surgery for acute pancreatitis. I had 8 weeks of diarhea (diarrhea) where I lost 30 lbs. During the surgery the doctor damaged my vagus nerve and I have had stomach paralysis for 4 years now. I have to take a medication to be able to digest food. For the last 18 days I am having severe and incapacitating chest, back and neck pains that the doctors can not figure the reason for. Today I started to develop abdominal pains along with the chest pains. True, I no longer have hearthburn, but I would prefer to have hearthburn and take nexium than having all of these complications. Please be aware that hearthburn surgery can mess up your whole life, even though the surgeon says it is an easy surgery.

[Bucks]

I just came back from my 2nd operation with this fundo wrap thing.  The first wrap was done 3 years ago and well I can say my life sucked.  If I ate anything I could not drink nothing other then water, caused to much bloating.  Could not belch or vomit, and this does not take into effect that just overall felling bad at times.  This 2nd surgey was done by a different dr. and he was only able to take the wrap half way down due to so much scaring.  From what I can tell now is I can burp a little easer now, but as far a being able to vomit is now a wait and see thing. The dr. stated that if I really wanted to take it all the way down that he would have to do another surgery openly.  So I going to try this fix for awhile to see if I feel any better at all, but to all of you out there thinking of getting this done, I would just say if I could go back into time I would just live and die with reflux this fudo thing has really brought me quality of life down.

[Aub]

Why did you have the Nissan surgery to begin with?

[Aub]

Please elaborate.

[janice roberts]

I live in South Africa and have used a product called "Motival" made by Bristol Myers Squibb here which worked very successfully and I experienced no systoms but I am now unable to purchase it South Africa can anyone tell me if I can purchase it elsewhere.  I have contacted Bristol Myers Squibb by e-mail but received no reply.  I have very upset that such a good product could be discontinued becuase there is no long any money in it

Janice Roberts Port Elizabeth SA