Questions regarding my Nissen Fundo Take Down

[Davmo88]

In January of this year I had a Nissen Fundo after it was recommended by a surgeon. I had been on prilosec for 5 years after seeing my family Doctor about a major burping problem I was having. He suspected I had GERD. My symptoms were basically after every meal, and even driking I would have to burp steady for sometime 20 minutes on and off to clear out the gas. This was my only problem. It was more of an inconvienience not a major problem. There was no acid coming up with these burps, only gas and air, and I couldn't tell you what heartburn feels like, never had it in my life. After following up with my family Doctor early last year he recommended I see this surgeon about my options. He ran a number of tests including the PH monitor, upper GI etc. They found no trace of hernia, and my PH test was very normal. The only thing out of the norm he found was a "Hypersensitive LES" while in a resting position, which no doubt caused me to burp allot. All the other GERD test found me to be completly normal. The results of these test were only known to me after the fundo surgery. Even though the PH tests were normal the surgeon still suggested the fundo and said it would cure my burping problem. I had the surgery on Jan 18/05 and I knew within one month it was a huge mistake. I was in terrible pain from the bloating, as I still had the urge to vent my bloating through burps as I did before but the fundo wrap wouldn't allow me too. I suffered terribly until March 18th when I had the surgery reversed, we'll almost, the surgeon could only take it down to a 180% wrap because the final anchor stich behind the wrap had to stay because it was consealed by scar tissue from the first operation and he said it was too close to the back vagus nerve and didn;t want to risk injury. So now here I am after having 2 pointless surgeries that had no chance of helping me because I never had GERD in the first place, or at least not nearly enough to warrant major stomach surgery, and I'm now having stomach and bowel problems. My symptoms are: My stomach has general pain everyday. When I eat my stomach now gets sore and bloated. I have dialy episodes of diarehha, and I now feel like I have GERD, as I have some of the typically symptoms I hear about like the burning stomach, acidic taste in mouth etc.. So my question is concerning the surgical procedure for both the fundo and reversal. I have read my surgical reports and no that I have had apprx. 10% of my gastric vessels removed and my hepatic branch was also sacrificed because apprently it got in the way during the fundo procedure. What could be causing these problems? The severed gastric vessells?, hepatic branch? could I have a vagul nerve injury? Can the body adjust, grow these vessels back and repair itself?

Have you seen someone have a fundo take down then have these kinds of problems then recover eventually? What would you suggest?

[Kevin Pho, MD]

I am not a surgeon, so I'm afraid my insight will be limited.  

The 24-hr pH test is the most conclusive test for GERD, and with it being normal, it certainly would be unlikely that the fundoplication would help.  

Other possible causes for the symptoms can include gastroparesis, gastritis, or irritable bowel syndrome.  

You have mentioned the upper GI.  You can consider an upper endoscopy - which would be the more comprehensive test.  A blood test for H Pylori can also be considered - since this bacteria is associated with inflammation and ulcers.  

If these options are non-revealing, you can consider optimizing your treatment for irritable bowel - first by increasing the fiber in the diet, as well as anti-spasmodic agents.  

It is possible that recovery can happen after a fundoplication take-down.  However, I would discuss this option with your personal physician and surgeon.

I also cannot comment on whether the removal of the blood vessels are contributing to your symptoms.

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.
Medical Weblog:
kevinmd_b

[Davmo88]

As follow up to my post above I should have pointed out that I would really appreciate if the Surgeon on this site would also reply to this question as it is very much a surgical related issue and problems I'm having as a result of this surgery. Thanks

[Davmo88]

Thank you Dr. for your response to my question. I would greatly appreciate if the Surgeon who visits this board would provide his thoughts and recommendations.

Thanks

[Inanga]

hi i had a nissen funiplication in 2001. I am not sure I really needed it - my symptoms were not typical. I since deiscovered that lots of my rouble have been cuased by food allergies - bloating, upset stomach, iritable bowel - like symptoms. I did have a slight hiatus hernia and there was inflamation (inflammation) so acid must have been a factor.

anyway the post op bloating was bad - i had a month or 2 of excruciating pain as gas worked it's way down rather than up. The pain was paralysing sometimes - I'd have to just lie on the floor and not move for an hour until it passed out. I think me intestines somehoe got used to the process becuase the pains came less often from several times a day to once a day then oce a week to maybe once a month. It took about 3 years but eventualy I could burp again - I guess it's loosening up again. I think my LES is working like a normal person's now so I'm happy at last. It was scary thinking the pain would never go, but it did.

good luck with what ever you get done.

[Inanga]

hi i had a nissen funiplication in 2001. I am not sure I really needed it - my symptoms were not typical. I since deiscovered that lots of my rouble have been cuased by food allergies - bloating, upset stomach, iritable bowel - like symptoms. I did have a slight hiatus hernia and there was inflamation (inflammation) so acid must have been a factor.

anyway the post op bloating was bad - i had a month or 2 of excruciating pain as gas worked it's way down rather than up. The pain was paralysing sometimes - I'd have to just lie on the floor and not move for an hour until it passed out. I think me intestines somehoe got used to the process becuase the pains came less often from several times a day to once a day then oce a week to maybe once a month. It took about 3 years but eventualy I could burp again - I guess it's loosening up again. I think my LES is working like a normal person's now so I'm happy at last. It was scary thinking the pain would never go, but it did.

good luck with what ever you get done.

[Isabeljo]

In 2000, i did have a nissan fundo but in my case it was essential as I had reached the stage of choking to death and all the tests were positive.  However, even though it was done as it should have been, I am experiencing similar symptoms as you. I used to have one BM per day and little gas but after the surgery, I get nauseated when eating, have several BMs and fart all over the place. What is worse is that I am not absorbing my nutrients and am dehydrated a lot. I told my gastroenterologist that sometimes if I ate fatty foods or too much, I felt like immediate nausea, weakness and fainting at the table.  He remarked that this was pressure on my vagal nerve.  So maybe you can get a surgeon who is willing to go in and remove the scaring and finish the takedown.  As for me, I think that the surgery was done for a good reason but it could have been slap bang thank you m'am...2 hours with a laparascope which I feel does not give the doctors a good enough view to be careful. Let me know what you think.  Contact me at ***@****
I wish I could get a surgeon who could go in and move things around properly.

Elizabeth

[pippylion]

I had the fundo op done two and half years ago because I had very bad acid reflux and hiatus hernia. For 18 months all was well except for regurgitation caused by my poor motility. Went out for a meal and ate very little as I was getting over number 3 dilatation and only had one glass of wine. My stomach all of a sudden swelled up to a 9 month pregnant lady with terrible sharp pain between the ribs which radiated to my back and shoulders,including wanting to be sick but couldn't.  To this day I am told I am suffering from gas bloat and hospital want to do another dilatation. I am at my wits end as I have to allow for expansion when buying cloths. I cannot go swimming, gym, do gardening or any physical activity as these all give me pain due to the expansion of stomach.  Can anyone explain to me why this has happened and will a dilatation cure me? The hospital are hoping the gas will escape easier. Incidentally I burp and pass wind as normal and I do not think gas bloat is the problem.  I am seriously thinking of having a take down and suffer with the acid as it has really messed up my quality of life as I am now.  Has anyone suffered a similar fate or can anyone tell me where I can get a specialist opinion who is experienced in this problem?