Stomach Pain post Nissen Fundaplication

[Ci CI]

I developed gerd about 15 years ago. I had to have the sticture in my esophogus (SP?) dialated about 6X at the rate of 2 times a year.  I also had a cough and was aspiraing acid from the reflux. I started with Tagament and am now on Acidphex. I've been on everything in between.  In Sept. of 2001 I had a laproscopic Nissen Fundaplication in Chicago.  2 months after that I had an emergency bowel resection for diverticulitis. I have not recovered since.  I lost 40 pounds, but have gained it back in the last year.  I had 3 episodes of severe pain and free air.  The doctors were going to operate but the leak closed and while they tought it was in the fundaplication they were not sure. My last episode with free air was in August of 2002.  Since then I have almost constant pain below the sternum and stomach area.  I have gone to the emergency room 3 times with severe pain, the last time a month ago. The xrays show no free air and no obstructions, but a severly distended stomach full of air - no food. They say it was the size of a loaf of bread. I have that same pain often and my stomach is distended like it was when the x rays showed it to so large. I know that Nissen Fundaplications are fairly new.  Is this pain common?  The surgeon that preformed mine is out of the picture. I have had every test possible and my Gastroenterologist is sympathetic but stymied. He thinks it may be something like Stomach Vulvitis? He has sugested Mayo's as they should be up on the after effects of this surgery.  What is your opinion?

Thanks, CiCI

[Kevin Pho, MD]

I would have this evaluated by a second surgical option to ensure this isn't a complication from the surgery.  Typically, pain should not be present 2 1/2 years after the procedure.  If not, I would assume that a repeat endoscopy has already been performed as part of the GI workup.  

If negative, other tests to consider would be a 24-hr pH study to ensure GERD isn't recurring post-surgery, as well as a gastric emptying scan to evaluate for gastroparesis.  Gastroparesis is possible in the setting of stomach distention.  

I would obtain another GI and/or surgical opinion and discuss the possibility of the aforementioned tests.

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

[nursedeb]

Hi,
I noticed you had a Nissen fundoplication. Was that to repair a hiatal hernia? I have a hiatal hernia and my symptoms are pain and especially spasms belows my sternum after eating. I was wondering if you had similar symptoms before your surgery.
Thanks,
Debbie

[tessa0825]

Nissen fundoplication creates a new LES ( reflux surgery) by using a portion of your stomach and wrapping it around your distal esophagus. They also do hernia repair as part of this surgery.

[Ci CI]

Hi, No, I didn't have this pain before the Nissen. My pain sounds like yours.  Under the sternum, after eating, but sometimes on an empty stomach too. It's like spasms and a burning feeling, and I get very distended.  I have trouble breathing from the pressure.

My surgeon claims these symptoms are not from "his" surgery so no help there.  I'm planning to go to Mayo's and I'll let you know what they say.

From your name I assume that you are a nurse.  I am too, although inactive.  

Sylvia  

[Ci CI]

Hi again, I just reread your comment and realized that you have not had a Nissen.  My symptoms before the Nissen were severe heart burn, difficulty in swallowing from a stricture caused by the acid, back pain radiating from the area of the sternum, and a chronic cough.  The Nissen cured the heart burn and all of the above except the cough that has returned.

Now I am back on a acid blocker and have new pain.  Bloating, gas, and the severe pain in the sub sternal area.  At first I was unable to eat except for small bites.  The Nissen makes your stomach smaller.  After 2 years I got my appetite back, but still feel better if I have very small meals.  

I can't say that I would reccomend the surgery. Although it cured those symptoms, I now have a whole set of new ones.

Your symtoms sound maybe like gall bladder to me.

Sylvia (Ci CI)

[renee1952]

Welcome to the world of post fundoplication...We seem to go into this surgery very naive in the fact we believe we might feel better afterwards..I'm almost a year after surgery and I have more stomach pains now than I did before surgery..The gas bloat is bad also..Im also back on PPIs already as Im still refluxing, swallowing is still a problem sometimes..Im not sure what it accomplished. I don't understand why Drs. don't more fully explain post-surgery consequences to us prior to having this done. To many folks have the same complaints afterwards for the Drs. to be totally unaware it is happening.

[surgeon]

It indeed sounds as if you are having "gas bloat" syndrome, which means the wrap they performed has made a valve effect that is too tight. Most gas in the stomach is swallowed. A normal valve allows it to be burped back up when necessary. If your stomach is the size of a loaf of bread due to gas, that implies that the valve is too tight. It can sometimes be dilated by a gastroenterologist to stretch it. Worst-case scenario is re-operation. Nissen fundoplication has, in fact, been around for decades. It's the laparascopic approach that's fairly new. You ought to get a surgical and gastroenterology opinion from a center where re-operative esophageal surgery is done frequently.

[nursedeb]

I am still having problems with my stomach, specifically spasms after eating. I also notice that I get the spasms sometimes when I cough, laugh, get up quickly or bend over. All that leads me to believe its my hiatal hernia, because all those things increase pressure which would cause the herniated portion of the stomach to push up more. It feels like a spasm when it happens. After reading all the horror stories that people experience after Nissen Fundoplication surgery, I am really not sure if I want to have it done. I am tired of living with this problem, but I don't want to make things worse.
Debbie

[tessa0825]

Give it (fundoplication) a fair evaluation ateast before making a decision. I have talked to alot of people who have great results from having fundoplication surgery. Many who haven't taken a PPI since surgery and some who say that their Barrett's esopahgus is nondetectable since surgery. Everyone goes into surgery with their own unique set of circumstances and complications. I was dissapointed in the results of this surgery but someone else might have great results with it.Most important is to find a surgeon who does alot of fundoplications and make sure he has a good success rate. Also important is to insist on all the pre-op testing to make sure your even a good candidate for surgery. Manometry, to make sure you won't have swallowing difficulties following surgery as fundo will create it's own swallowing problems for awhile. 24HR PH study to document that GERD is actually the problem and that something else isn't being overlooked. Remember, it is a sugery to create a new LES, if your LES isn't the problem then fundoplication wouldn't fix you.

[Ci CI]

Hi, I'm still complaining about pain since I had my Nissen Fundaplication in 2001.  Severe bloating, but I can belch and swallow OK. All tests are normal. No obstruction, but my stomach gets the size of a loaf of bread.  Small meals help, but about twice a week the bloating is so bad that the pressure causes a lot of pain and literally a pain in my neck!  This pain is severe.  I experience it the first time in the recovery room. I was screaming with pain and they brought in a portable chest x-ray and ekg. I stayed in the hospital the next day and everyone seemed at a loss to explain the continued pain in my neck and shoulders.  I've been doing some reading and am wondering if they nicked the vagus nerve. I also had a seizure while undergoing a lower G I test.  It happened when I was in the hospital with free air.  I am going to a different surgeon in Chicago tomorrow and I'll let you know what he says.  If anyone else has had this  problem please let me know.

[Vegas1]

This is to everyone here , I use to over eat then make myself throw up I had acid refluxe disease well 5 years ago I started to have spasms in my legs arms neck then one morning I took a sip of coffee , and my heart went way out of it's normal beats ekg was fine but then I developed breathing problems tackacardia or svt's They put me on all this heart medication That dropped my heart rate way down almost died I got to the point where i couldn't breath air under 75 or every artery in my body would close a few months into this the docters took me off the meds because they almost killed me and sent me to a gastro md they found a hiatle hernia and put me on proton inhibiters Well Now I am choking On my food and know what can set this off I know now with out a dought that my "VEGAS NERVE" Has been disrupted and the only way to stop the symptoms is to get surgery. What I have is called HHI/VNI Hiatle hernia syndrome vegas nerve imbalance that can lead to all kinds of ailments in your body. O and by the way I developed severe floaters from the toprol because my blood pressure droped so low , that I had a TIA Anyway I am in HELL but have a computer and lots of facts now This websight has helped me deal with it better It's www.wellatlast.com

[Vegas1]

This is to everyone here , I use to over eat then make myself throw up I had acid refluxe disease well 5 years ago I started to have spasms in my legs arms neck then one morning I took a sip of coffee , and my heart went way out of it's normal beats ekg was fine but then I developed breathing problems tackacardia or svt's They put me on all this heart medication That dropped my heart rate way down almost died I got to the point where i couldn't breath air under 75 or every artery in my body would close a few months into this the docters took me off the meds because they almost killed me and sent me to a gastro md they found a hiatle hernia and put me on proton inhibiters Well Now I am choking On my food and know what can set this off I know now with out a dought that my "VEGAS NERVE" Has been disrupted and the only way to stop the symptoms is to get surgery. What I have is called HHI/VNI Hiatle hernia syndrome vegas nerve imbalance that can lead to all kinds of ailments in your body. O and by the way I developed severe floaters from the toprol because my blood pressure droped so low , that I had a TIA Anyway I am in HELL but have a computer and lots of facts now This websight has helped me deal with it better It's www.wellatlast.com

[voyager79]

I find reading your comments interesting. I have GERD and IBS and have had it for 7 years. I have a history of ulcer in duodeum, stomach and esophogus. I did not have h pylori. I was diagnosed with a hiatil hernia last year. Since then I have had a hyterectomy and after I had complications with 2 ileus. A few months later I had my last ovary took out due to ruputured cyst and also had extensive scar tissue removed. I had an ileus after that and a large bowel obstruction. I spent alot of last year in the hospital, getting released christmas eve. A week after I was released my scar burst open from my belly button down. It took months to heal and I have a huge yucky scar. 2 weeks ago I went to the Dr with severe pain in the area above my belly. When I lay on my back it was a 10. They took xray and said I was full of stool and gave me stuff to drink to empty it. It did a little, but I am still having pain and after I eat my upper stomach is extremly bloated and hard to the touch. I have rapid breathing and I pretty much am stuck at home with the pain. I really think this has to do with my hiatil hernia but I am not sure. I dont have a gallbladder appendix or a right kidney. Does anyone have any comments or suggestions. I am at a loss and I want to get on with my life.