Nissen redone

[Dobit]

I had the Nissen done 4 years ago after 19 years of many digestive problems. My mother died of stomach cancer when she was in her 50's . I am having symtoms again like before I had the surgery and at the moment going throught he scope tests to see if surgery is needed.  All i can say is that I felt so well after having the Nissen done. I want it again as my esophagus has more damage.They took biopsys for  The DR thought I may have barretts... As it turns out I do not have that ...yet. I want it done again to prevent getting cancer  and the way I feel know is getting worse . The dr seems to think I do not need it as the PH test came back that I ( for that one day) did not have reflux. I must have it as the symtoms I have are 100 % the same as before . sore throat, feel like I have a golf ball stuck there, chest pain and my Ashma has gotten worse. I can not eat meat as this about kills me.  I just want to know if anybody out there that has had it done again are glad they did. The dr made me feel like I did not know what I was talking about today and seems to think that being on more PPI's will make it better. ( It did not work before)


This discussion is related to Anyone have to have Nissen Fundoplication TIGHTENED???.

[bodyisolderthaniam]

Dear Dobit:
I had the surgery done a few weeks ago so I personally am not going through your recurrence issues- however, my mother has a co-worker who had the surgery about the same time you did and she is now looking at having it redone.  She HAS to stay on it as her hiatal hernia was pressing against a cardiac nerve and it was causing mini-stroaks.  There are cases where the wrap loosens and they go back in and wrap it again-  I don't know why they would be worried about adhesions (scarring) as they design the procedure to build scar tissue (although to be honest I have not gone through med school and they have so I don't question a lot of what my doc has to say).  All I can tell you is that it can be redone and hopefully I can report back with her results in less than the 4 months it took to get mine done.

[Alongroad]

I have had the Nissen down twice. The first time was in July of 2007. Then I was experiencing pain again in August of 2008. After several tests were ordered, it was determined to be my gallbladder. In November, 2008 I had my gallbladder removed by the same Dr. that did the Nissen. While doing the gallbladder removal, he checked on the Nissen and found that it had come undone(some what; not all the way) and it was stuck behind my diaphram;causing pain as well. So the Dr. had to redo the Nissen at that time as well. Now here it is almost six months later and I am in more pain now then before! I am so frustrated that I could scream! Something is not right! I can tell that the Nissen must be stuck again and now I am also experiencing acid reflux systoms. The pain is really intense. I have called my Dr. to let him know and now he wants to put me through a bunch of tests again..................Which I understand but my Dr. is two and a half hours away and it's just difficult finding the time from work to travel there. I first asked my Dr. if I could just live with this "pain" because I did not want to go through this a third time. If the Nissen were "stuck" again, say behind my diaphram, is that a condition one could live with? He said yes, but then the pain became to severe so I now have to proceed with the long journey of trying to find out what is wrong now. After my first surgery, I had prjectional vomitting, due too a reaction to my pain medication, which may of caused the dislocation.In November I again had projectional vomitting so that is why I believe the Nissen has become dislodged again............All I really know for sure is that I am in pain and expect to have a Nissen done for a third time.
Alongroad

[Alongroad]

I also want to mention that I have Barrett's so I am concerned about getting this "pain" corrected. If you are experiencing pain or discomfort, continue with your search for answers. Good luck and if I can discuss more with you, just let me know.
Alongroad

[iva_s]

Dobit,

I am sorry for your problems, I just want to ask you if you had bad breath besides "sore throat, feel like I have a golf ball stuck there, chest pain and my Ashma has gotten worse". Please, let me know, it is important..

[SurgeryVet]

Hi! I am a 48 yr old female who has had so many abdominal surgeries, I must hold some kind of record - I had a C-section in 1990, my appendix out in 1991, my gallbladder out in 1999, and scar tissue removed in 2000.  I also have had 4 Nissen Fundoplications along with paraesphogeal hernia repairs.

Specifically, I had my first Nissen Fundoplication in 1997 just after my father passed away from esophageal cancer which he developed after a lifetime of GERD and eating Tums & drinking Mylanta.  I had the 1st surgery in a local small community hospital by a surgeon who said he had done about 40 of the NF by laporscope.  The day after my surgery, I knew something was horribly wrong. It was written off to "post surgical" symptoms. I found out later it had been botched 100% and almost killed me. Thank God my primary care dr got me referred to a large university facility several hrs away and I had my second fundoplication by laparoscope 4 months after the 1st. That surgeon is world reknown for these surgeries and said he had never seen anything so screwed up in his life.  I did really well for another 6-8 months and then started to have problems again, lots of pain, dry heaving, etc... I was referred back to the university surgeon and he scheduled me for my third procedure in 1998... this time it was an open procedure and I was in the hospital 12 days. He followed my progress for yrs and I was doing well when I went to see him for my 5 yr visit.

I continued to do well until last summer in 2008. In Sept, I was admitted to my local hospital and found out I needed another Nissen Fundoplication and that I also had a very large paraesophageal hernia. I spent most of December & January in a local hospital just treating symptoms. Due to problems with my HMO, it took almost 4 mos before I was finally referred to a different university hospital, 4 hrs away from my home.  (My condition was too complicated to be done at a local hospital).

I just had my fourth Nissen and hernia repair by a great team of doctors in March 2009. They also cut the pylorus (a presurgical gastric emptying test showed I was only emptying 13% after an hr). I was doing extremely well for having had my 4th procedure initially, but am now having problems. My wrap is too tight, so I am having trouble swallowing and eating. I also have pain (sometimes extreme) while eating and even feel choked sometimes just drinking water. My surgeon is trying hard to help.  I am now scheduled for an EGD to "stretch" the wrap. I am also starting to suffer with intermittent diarreah, sometimes while sleeping and it doesn't even wake me up. I am concerned about "dumping syndrome" due to the pylorus being cut.  I also worry that the vagal nerve(s) may have been nicked or damaged during the surgery.  

I have continued to lose weight, over 40 lbs since January, but definitely not a diet I would recommend to anyone. I still have a G-J feeding tube in my stomach (put in during sugery in case it was needed during the healing process). I have actually started to use it, since I continue to lose weight and can't get nutrition any other way. Hopefully it will all work out for me. I think 4 fundoplications may be a record!  The sad thing is the first one was done to prevent cancer like my dad had.  One of the surgeons told me that every time you have this surgery, your chances for failure double... my  chances don't sound too good.  A fifth procedure, if needed, will likely remove my stomach out permanently, leaving my esophagus hooked directly to the small bowel. I will just put it in God's hands and pray for a good outcome.

Has anyone else out there had this many problems? Please advise. Thank you!

[Kent2008]

I had the Nissen redone about 10 days ago because I was having some chest and shoulder pain as it had slipped.  But now the same pain has started to come back.  Is it too early to tell something went wrong?  I don't feel good about it and worried.

[Karrimac53]

I am scheduled to have a redo on 16 July, does anyone have positive outcomes with this?  

[coughting]

I have had a Nissen but have not had to have a redo.  Find the best bariatric surgeon in your area and only let him do the Nissen.  Ask him about a loose wrap which will minimize any feeling of food being stuck.  Also, after the surgery eat nothing but liquids for 2 weeks.  This is hard but it will prevent the shoulder pain,  back pain and feeling that somehing is stuck.  Give it time to heal before you eat even soft foods.  I found that oatmeal was my saving grace during these weeks.  I felt like I was getting something to eat.  Also, I would put potato soup in the blender or you could just make sure the potatoes were mash up real well.


I have not had any problems since my Nissen.  My surgeon was a bariatric surgeon that had performed a bowel resection, due to chrons, and I had recovered quickly from that one also.  So I really feel it is important to reseach the dr and use a bariatric surgeon.
They have performed thousands of this procedure and experience counts.

Best of luck

[angryfemale40]

Hiya.I have got to have my Nissens redone,as the surgeon said my one has been done too tight.Now face surgery in October,hoping for that date to be bought forward...its a nightmare.ANYONE that has had a Nissens re do...please any info would be grateful!! Ta!!

[coughting]

No, I have not had to have my Nissen redone.  My surgeon did the loose wrap to begin with.  I did not have any problems.  After I left the hospital I was on liquid diet for a week and 1/2 until I saw the dr.

The one thing I found was that if I ate or rather drank more than a cup of anything then I would have gas pains.  I did eat oatmeal a lot as this is considered liquid (not clear liquid).  I lived on the oatmeal and blended lots of soup.  Because of this and eating only a cup at a time, every couple of hours, I never felt like anything was stuck in my esophagus.  

I am able to burp and have had no problems.  The surgeon makes the difference.  Make sure he is a bariatric surgeon with 1000s of Nissens under his belt.  That he is good with a loose wrap and you will be fine.

Best of luck

[Sickboy1]

The Nissen fundoplication surgery is not always successful, for a few people the Gerd symptoms come back within two years and for 3 out of 10 the Nissen just does not work.
It is major surgery with high risks of it not solving the problem, the surgery only achieves taking you off acid blockers, and then there is a high risk that you may still have to take acid blockers for the rest of your life anyway, so it will all be for nothing, this should have been explained before you chose to have the surgery.

The severe pain describe at the esophageal sphincter is most probably an esophageal spasm, which is brought on by years of acid damaging the lower esophagus.
The fundoplication will still be strengthening the esophageal sphincter and stopping the upper stomach sliding through the diaphram, so before having it rewrapped again try something else and realise that the Nissen procedure may not be the way forward for you.

If this works then you know the way forward, take calcium channel blockers(preferably Nefedipine) which will relax the esophagus, in combination take acid blockers every 12 hours to stop acid from aggrevating the esophagus and causing a spasm, you may also have to take acid neutralizers in the period where one acid blocker is wearing off and before taking the next, it is important to have 100% acid neutralization in order for this treatment to work.

This treatment is not effective unless linked to some diet and lifestyle changes, this treatment should be have some effect after just one month.

Plenty of rest is required, your sleeping position has to be elevated, a steady walk after each meal(light excercise), small meals regularly, no fatty foods, no sweets or cakes, no alcohol, no smoking, no strenuous activities. Avoid all other foods that can cause acid reflux, like speramint and peppermint, spicy foods, acidic foods etc...make foods easily digestible, i.e. mashed potato with vegetables and steamed fish, make sure you do not eat late at night.

This is the hardest part, try to avoid stress or tension, which is very difficult considering you have a nasty illness constantly looming, practice breathing excercises and exhaling all the tension, if you have a stressful job then you need to take time off work whilst doing the treatment, if you can not afford to do this, then you just have to take things easier and try to not let things get to you.

One thing you will never read in any medical forum, this helped me a lot, pure isolate whey protein drinks, they help strengthen and repair the muscle tissue, easily digestible, full of energy, low in fat.
Beware of eating too many high carb foods like pasta, not easily digestible and in the opinion of many atheletes can weaken the stomach linng, just like too many sweets can thin the tooth enamel.

Good luck, i hope it works out for you, i ended up diagnosing myself after years of banging my head against a brick wall with doctors, even then i had a battle convincing the doctors to accept my diagnosis,they say they do not know what is causing the pain but when you propose something they will disregard it, they seem to overlook one significant point, you are ill and in pain and something must be causing it. They need to inherit airline pilot mentality, i.e. if you go down then so do they, if this were the case i'm sure they would not be so lax at letting you crash and burn, in cases that are not text book the system can fail and they will diagnose stress and close the file, but not all doctors all like this, some will explore all avenues and even carry out research and without exhaustion will carry on trying different treatments to see what works. i.e. calcium channel blockers are normally presrcibed for relaxing the esophagus, but a thinning of the esophagus wall due to long term damage can leave raw nerve endings, and it may be worth to try baclofen to relax the esophagus which helps cancel the nerve signals and works more on the spine, this can have less side effects on the brain and the heart but as a downside can cause stomach upset, but this stomach upset would be very mild compared to the upper abdominal pains, in fact you would probably not even notice it.
Find a doctor who is sympathetic to your condition, but most importantly you have to help yourself, this is ultimately in your hands, you are flying the plane, think of the doctors as ground control.

[coughting]

No surgery is not to be taken lightly.  However, years of burning the espphagus does lots of damage.  My mother-in-law died from this so it is also not to be taken lightly.

Try all alternatives, consult with your doctor and YOU and only you should decide.  

There are a lot of surgeons that will perform this surgery, however, once again you need to have a bariatric surgeon who is skilled at this procedure.  Is able to do a loose wrap.

I personally think that is why there are so many people out there who are unhappy with the surgery.  Do your homework on any kind of surgery and also on the surgeon.

Best of luck

[slnetter]

In Nov. it will be 9 years since I've had the Nissen done.  Best thing I ever did.  No more waking up in the middle of the night coughing and gagging because the reflux came up so far it went down my windpipe.  Now after 9 years, I'm having to clear my throat 1000 times a day.  I've had 3 sinus surguries, but my ENT (who didn't do these surgies) thinks it's reflux. All I know is that if my nissen loosened up I'm scheduling a redo as soon as possible.  Best thing I ever did. By the way, I do have Barrett's Esophagus also and really don't want that to pregress into anything else.  I've heard the horror stories about some of the surguries but mine went so very well.  The liquid diet in the beginning kind of sucked but easy enough to get through.  

[CoughingGirl1625]

I had my Nissen in 2001.  It has come undone and I'm seeing a bariatric surgeon next week on July 30, 2009.  As I read the comments above I think I'm seeing the right person but I want to have a list of questions about a re-do (if needed) so if anyone has any suggestions I would appreciate your assistance.

Thanks!

[coughting]

Here are a few questions.
1.  How many laproscopic Nissens have you done
2.  How are you at a loose wrap
3.  Do you suggest a loose wrap

You made the right call by seeking a bariatric surgeon.  If you don't like any of his answers go elsewhere.  If he doesn't say he is great at loose wrap, go elsewhere.  You want this surgeon to be very self confident and able to preform the loose wrap.  That is where most people's problems occur.  When the wrap is not loose it causes all sorts of problems.