back pain after laparoscopic nissen fundoplication

[sarahcc]

My daughter is 24 years old and she had fundoplication for reflux 8 weeks ago. She is making a very poor recovery: she must take stematol to combat nausea on eating, suffers exhaustion, unable to work, and worst of all she has back pain after even a small amount of exercise.She says she feels as if somebody has punched her in the back. The pain is provoked by exercise, not eating and she is unable to stand up completly unright. She had none of these symptoms before the surgery. Her reflux has gone, and she can eat nearly normal food, but must snack frequently because she feels full after a small meal, but weight loss has halted.
Her surgeon says that back pain is quite a common post operative symptom, but I have been unable to find any reference to this problem for fundoplication. He is sending her for a barium meal, but this does not seem to address the problem.
Please give your advice.

[Kevin Pho, MD]

As has been commented below, back pain is fairly common after abdominal surgery.  Causes can include irritated nerves referring pain to the back, to the healing process exacerbating the back pain.  

If the symptoms continue, I agree with the suggestion that a CT scan be considered to evaluate for things like an abscess - which is certainly a more serious cause of the symptoms.  

You may want to discuss this option with your personal physician.

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

[surgeon]

Back pain is fairly common after any form of abdominal surgery. The causes are many. There can be referred pain from irritated nerves. There can be stresses on the back muscles because the abdominal muscles have a lot to do with the carriage of the back, and they are affected by the surgery and the healing process. It's reasonable to look for unexpected causes after some time has passed, and the surgeon seems to be beginning the process. A CT scan would be a consideration also, to look for other explanations such as an occult abscess, pancreatic problem, etc. But statistically speaking, it may well just be part of the healing process -- a somewhat vague but real situation -- that will slowly resolve with more time.

[kimbacat]

if the testing doesn't show anything, you might consider that your daughter might be unconsciously favoring some of her abdominal muscles or maybe strained some back/abdominal muscles while recouperating.  I've had several abdominal surgeries and this is very easy to to.  tensing to avoid the pain or simple things like moving the wrong way while trying to get out of bed or reaching for something overhead can strain muscles.  maybe when she exercises she could be straining the overused muscles.  heck, hospital beds themselves will throw your back out of whack.  I would suggest trying massage or maybe a chiropractor.  her family doctor can give her simple exercises to help regain any strength that might have been lost in her abdominal muscles which will help her back.

[renee1952]

Nissen fundoplication is not as easy a surgery to recover from as some would have us believe. I had this surgery 13 months ago and for the first 8 months I thought it was a really big mistake. 8 weeks in the healing process is really not long. Gas bloat alone that is prevelant with this surgery can cause all sorts of pains and bad pains too. There is a web site www.heartburn-help.com that has a forum dedicated to fundoplication. You coudl visit it and read some of the healing and recovery processes different folks have experienced.

[sarahcc]

Thank you everybody for your comments. It is very confusing when your surgeon and websites say back to work in 2-4 weeks and the patient is still pretty ill after 8 weeks. Renee or anybody else please can you tell me if the pain from gas bloat occurs mainly after meals, during exercise such as walking or at any time.
Thank you

[renee1952]

Hi sara, the gas bloat seems to occur at any time but mine was worse after meals. A problem I noticed with the gas pains is of course you usually can't burp after fundoplication surgery, so the pains can become very painful as the gas works itself through the system. She may want to try cutting back on solid foods again for awhile. I had to do that several different times. Let things calm down with just liquids and very soft foods and then start slowly increasing solids again. Also, GAS-X and those type pills might help some. It has taken many of us months to learn to deal with the stomach pains and gas bloat following fundo surgery. I do hope she finds something that makes her feel better again. The good news is that once I got past the gas bloat (8) months things started settling down alot.

[MOONGLOW]

Don't want to alarm you, but I had the Nissen in May 2001 and in July 2001 I started having severe nausea and vomiting.  After a year of symptoms and in and out of the ER I was finally diagnosed with gastroparesis.  You get this diagnosed with a GES (gastric emptying study).  Mine came back significantly delayed.  They think that maybe the vagus nerve was damaged during the surgery or adhesions.  I live with nausea every single day of my life and am on antinausea medications around the clock.  Get on line to look up gastroparesis and see if the symptoms fit.  You might want to mention this to your GI doc and see what his thoughts are.  I don't want to scare you but this is what my experience has been.  The Nissen was the biggest mistake I have ever made.  I do not have GERD anymore but I would rather deal with that than the nausea and vomiting.  

Good luck and don't give up and keep pushing your doctors.  They seem to just ignore the symptoms.  If it does not go away in six months I would definitely ask for a GES.

Moonglow

[casey88]

My wife also complaining back pain after removing gall bladder surgeries. This pain has been a few weeks after the operation.
Before the operation, she is complaining back pain after meal. After go for sound scan, doctor said there is 10mm gallstone. The only solution is removing the whole gall bladder by laparoscopic method. However, after operation, the back pain still happened anytime, whether you are sitting, sleeping or standing in any position.(More than 4 weeks)
After going to see a few doctor, all of them just recommend go for CT scan. But result is nothing. Again, the doctor just give us the painkillar. It does not help at all.
Now, I advice from your all. What cause this pain? Due to Gas in the abdomen? Please help.

[Kent2008]

A related discussion, Back and Shoulder Pain after Lap Nissen Fundoplication was started.