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Problems eating after fundoplication
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Problems eating after fundoplication

I had an open procedure for repair of a hiatal hernia; the surgeon also did a fundoplication.  After being discharged from the hospital, I had problems with nausea, vomiting, and diarrhea and ended up back in the hospital after five days, had a PICC line inserted and was on TPN.  After 10 days, I was discharged again.  I continue to have the same problems.  Two days ago, my surgeon did an endoscopic dilation.  Again, no relief.  After eating only a few small bites, I have to try to force myself to burp before I can try to eat anything else.  Most often, after burping, I spit up some of the food.  Drinking anything is even worse; I can't seem to keep any liquids down.  I get the feeling my surgeon thinks I should be patient, but it has been 12 weeks and I haven't had a real meal since before the surgery.  I have lost 27 lbs. so far.  I sometimes feel I would rather have tube feeding than to go through this 24/7.  Is there any hope that this will get better, or will I have to undergo surgery again (not what I would hope to do, it's been a long recovery).  Should I see a speech therapist and have swallow studies done; should I see a gastroenterologist?
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16 Comments Post a Comment
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Avatar_n_tn
It sounds like the surgeon did the wrap too tight, however, if that was true you shouldn't have been able to vomit.  A gastroenterologist might be the next step.

Eat only a 1/2 cup at a time and do this every 2 hours.  This should give you some relief.  Never eat more than a 1/2 cup at one time until you are better.

I had a loose wrap but have not spit up anything since.  I do burp.

Why did he do the open vs laproscopic?  Was the surgon a bariatric surgeon?
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Avatar_f_tn
The surgeon who did the repair was a thoracic (chest) surgeon.  He did it as an open procedure because he said my esophagus was not long enough to do it via laparoscopy.  It isn't the amount that I eat at one time, sometimes I only take a couple of bites and it feels like the food is stuck in my throat and won't go any further.  When I finally burp, sometimes just a bit of the food comes back up with lots of mucous.  Othertimes, it all comes back up.  Drinking anything, including water, is even worse than eating.  I am going to try to add thick-it to my drinks to see if that will help.  I have another appointment with the surgeon next week.  I really don't look forward to having another surgery, if I have to go through months of recovery again.
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Avatar_n_tn
I had a nissans performed a few years ago and have had problems eating ever since.Dispite 4 dilations I still could not manage solids and eventually when my weight had fallen to seven and a half stone I changed consultants.The nissans was refashioned and things have improved somewhat.My surgeon now thinks it is oesophageal motility problems which are making things worse and there is not much they can do for that so I live with it and eat carefully.
Following the last op I am now refluxing as badly as I was efor I had operation but the meds to seem to be of more help than before so I count my blessings.
I do think you need to get oesophagal testing done as that will effect your abilty to swallow and that will effect how tight your wrap needs to be.
Kate
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Avatar_f_tn
That's exactly what I am afraid of, that I will have to live with this forever.  My mother had the same thing, and lived with it the rest of her life.  Dilations never seemed to help her.  I am afraid to do the surgery again, what if the results are no different?  I would rather live with a feeding tube than to have this constant nausea and vomiting.  I would rather have reflux than this.  At least before Zantac helped with the reflux.   The only reason I had the surgery was to repair a very large hiatal hernia; my stomach had slipped up into my chest and I was having chest pain when I ate.  I am wondering which is worse at this point.
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Avatar_n_tn
This is so hard,I suppose it was a bit easier for me to have further surgery because they managed to do both procedures laproscopically but mentally it was a killer.
Would they consider feeding you via a ngt for a short while just to give you a break, my surgeon was going to do this for me as I was in such a bad nutritional state and he was not sure he should operate because of the risks but my good friend was a consultant anaesthtist and she persuaded him to go ahead and she would be with me.
Did you have oesophageal monitoring befor you had your op? I did have this done and it was borderline , I honestly think that warning signs were their they were just ignored,mind my reflux was completly resistant to treatment so it was a bit of a difficult.
situation.
Hope you get some help soon.
Kate
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Avatar_f_tn
I am sorry to hear your reflux is as bad as before the surgery. When I went to talk to the surgeon before having the open procedure, I told him I was afraid of it all (my blood pressure, which was always low, went through the roof) because my mother had a hiatal hernia repair via an open procedure, had dilations all the time, and had problems eating for the rest of her life.  The surgeon assured me that the procedure was better than back when she had it, but I believe he made the wrap too tight.  One article I read said that surgeons tend to err on that side instead of too loose, because they don't want the reflux to be a problem again.  I wish he had just repaired the hernia, put the stomach back where it should have been, and not did the wrap.  I'll see what he says next week and go from there.  At this point, if he suggests further surgery, I am thinking of getting a second opinion in a large medical center in Boston, 4 hours away, but maybe worth the trip if it will get done right.
I sure hope you feel better yourself.  Sounds like you have been through hell, too.
Maggie
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Avatar_n_tn
If the procedure had been done correctly, you should not be spitting up anything.  I have a loose wrap and can burp etc.  I would question the surgeon regarding how many procedures he has done laproscopically.  Why you would be spitting up and still not be able to swallow.

I would get a second opinion before I would let him operate again.

I may be all wrong, but it doesnt sound like he did a good job and his reason for an open operation doesn't fly.

Good luck
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Avatar_f_tn
Thanks for the answer and good wishes.  I am going to see the surgeon again tomorrow.  I believe the wrap is too tight, and if they have to operate again, I will definitely be checking into a second opinion at a Boston hospital, even if it is 4 hours away.

Maggie
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Avatar_n_tn
Yes, and check out bariatric surgeons.  Make sure they are skill with lapro surgery.
Because it was once opened they might have to do it that way, but I would doubt it.
Also did you have a hiatial hernia?  Was the surgeon a bariatric surgeon or just a general surgeon.   My gastro dr had used one surgeon for bowel resection etc. But when I had to have bowel resection due to chrons I asked about l him to find one that did lapro and it was a bariatric surgeon and he did a great job.  When I later had the fundo surgery the same surgeon did that and I have had no problems.

Let me know what you find out and yes, I would go to Boston.
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Avatar_n_tn
I have had two nissenfundoplycations, one open, one lap....first one was great, but after 8 yrs slid down (the open one). I had trouble eating much at a time at first, but it got better with time.  You are still healing you know.  I would not recommend a redo to anyone, the second one was a disaster. The surgeon insisted on doing it lap despite my concerns, he promised to open me if he could not see due to adhesions....he did not. After 5 hours of cutting through adhesions, he finally got to do the surgery he was in there for. He punctured my lung in the process and he cut the nerve to my stomach. My hiatal hernia is worse than it ever was now, I have chronic gastritis, and esophagitis, food in my stomach that doesn't move out, and bowel obstructions due to the adhesions that have grown back worse. I take more meds now than I ever did. It was not worth the problems to redo the surgery. I would not have had it done again had I known it could be this big of a problem.  MY ADVICE IS DO NOT HAVE A SECOND ONE IF YOU CAN AVOID IT!  
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Avatar_m_tn
I am going to have a fundoplication as well for my hiatal hernia and have my gall bladder removed at the same time. I was wondering how long your hospital stay was, did you have a tube in your nose when you woke up, how was the pain level, did you have to have a special diet before the surgery or do a bowel cleanse? What were you able to eat after the surgery? Did you have to take any kind of pain pills afterwards? I am freaked out about it as I have heard so many people have problems afterwards. I just had a total thyroidectomy by the same surgeon and it was a piece of cake, very easy, no pain at all ten days ago. June will be the next two surgeries at once. I am afraid I may have to spend one or two nights in the hospital when I have both at once. I hated staying in there even one night for the last surgery. Any help appreciated. Thanks, Linda
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Avatar_f_tn
I will try to answer your questions one at a time.  First off, I had an open procedure, not a laparoscopy.  I doubt the surgeon would remove your gall bladder at the same time unless your procedure was being done via laparoscopy.  I had the same question when I had my gall bladder removed, and the surgeon would not allow it done at the same time as an open procedure, which is a major surgery.

The hospitalization for an open procedure is 5-7 days, for a laparoscopy it is less (2-3 days), but then you are having your gall bladder out at the same time, so it may be longer.

All my answers are based on an open procedure, it may be different for a laparoscopy.  Yes, I had a naso-gastric tube as well as a chest tube.  No special diet before surgery, just nothing to eat or drink after 9 p.m. since my procedure was very early in the a.m.  No colon cleanse was needed.  The pain for an open procedure is much worse than a laparoscopy.  I had an epidural inserted for pain medication while in the hospital, and pain killers were prescribed for after (but they made me sick, so I only took Tylenol).  I was very worried about the pain, but the pain was not a problem.

After reading about so many complications after a fundoplication, I don't know that I would do it if there was any other way to control the acid reflux.  In my case, my stomach had slipped up into my chest cavity and was causing severe pain when I ate, so I had no choice but to have the hernia repaired.  The surgeon said the recovery time would be six months, but I didn't anticipate 6 months of eating problems.  The only pain I currently have is my ribs, from having them spread for the surgery.  They get really sore and I have back aches, but Tylenol is all I take for the pain.  

Good luck to you.  I hope it all goes well.  When I had the laparoscopy for gall bladder removal, it was a piece of cake, got over it fast, and went home the same day.  I hope yours goes that well.

Maggie
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Avatar_n_tn
When I had the fundo by lapro I was in the hospital 1 night.  After the surgery I could only have full liquid meals until I saw the dr in 2 weeks.  I could only eat 1/2 cup at a time every couple of hours.  By doing this, I had no gas pains that others often mention, no shoulder pain.  The one time I ate about a cup I did experience some pain.  Went for a walk and it went away.  After the 2 weeks I could eat normally.  Just be sure and chew your food very very well.  The only lingering problem is gas.  The gas level is higher.  I do take gas-x and it help.  

I would do it again.
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Avatar_m_tn
Thanks for all the help. I guess liquid meals for a while is the way to go plus eat very little of soft foods when I get on soft foods for a while. I need to lose about 30 pounds so I guess that is going to help me. I sure am not looking forward to having both procedures done at the same time. I am going in May 6 for the esophagogastroduodenoscopy   and the bravo capsule done at the same time. The GI doctor told me to stop my omeprazole for seven days before the test. I don't know how I will survive. If I forget to take it each morning by ten oclock I am in agony and know I forgot it. One day out of town I did not take it until returning home at 4pm and I was in constant agony all night. How do others get through not taking it for that long. Plus two more days of not taking it while the bravo capsule is in place. I heard some people swallow the bravo capsule. He is going to PIN it into place in the esophagus he said. I heard people say they could feel it when the food went down their throat. Also problems of it not dislodging after the two day period. Ugh, not looking forward to any of this at all. My thyroid surgery was a piece of cake, no stitches, staples or pain. Just the glue. Yesterday at my preop he said no signs of cancer and I was healing well. He said not to take off the glue as I was still quite swollen. I sure miss soaking in the tub. I hate showers but have been taking them since the surgery March 26th. Thanks again.
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Avatar_n_tn
Eat only bland foods, full liquid diet might help.  Nothing spicy at all.  Sleep in the recliner instead of the bed.  Also, drink lots and lots of water.  Do not drink anything when eating.  East slowly and wait at least 15 minutes after to drink even water.
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Avatar_f_tn
Good luck with the surgery and recovery.  I am sure you already know the foods to stay aways from - caffeine, chocolate, alcohol, acidy foods and juices, carbonated beverages, as well as spicy foods.  Can you take anything else, like Tums or Mylanta instead of the Prilosec?  I was on a liquid diet for two weeks after the surgery, then put on a soft diet.  Right from the start, even with the liquids, I could not eat/drink.  It wasn't a problem of small bites chewed well.

Yesterday I went for the Upper GI Series and after talking with the radiologist, he seems to feel that I do have an esophageal motility problem (weakening of the muscles in the throat that push the food down into the stomach).  It usually is a result of GERD over the years.  Looks like more tests to see what can be done for that, and the condition is not a result of the surgery itself.  I was having problems for a few months before I had the surgery, but it was blamed on my stomach slipping up into my chest cavity.  It now looks like I had this esophageal motility before the surgery.  It would have been discovered if I had an esophageal manometry test done before the surgery, but it is not a normal procedure when they feel the problems are related to the hiatal hernia & acid reflux.  

Best of luck,
Maggie
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