results from nissen

[dee,rn]

I had an EGD yesterday with diagnosis of 5 cm hiatal hernia and eophogeal junction opening - in other words, lots of GERD.  I have had a chronic cough for several years that i believe is from my GI problems.  Have taken Prilosec, Protonix, Tagamet, Zantac with no relief of the cough.  I'm now considering the Nissen - I'd like comments, positive and negative.  I'm tired of coughing and want to believe this would help.
I understand it's a tough surgery, but if the outcome was good, I'd go for it.  Please let me know what ya'll think.  Thanks

[Abbey]

I say go for it. My girlfriend had it after suffering for YEARS!!!! She's now feeling well.

Good luck to you,
Abbey

[JackieG]

Hi Dee:

In 1991, I had an "open" nissen fundoplication, which is a tough surgery. It was accomplished via a nine inch incision from breast bone to navel, through the abominal muscle wall. Fortunately, it is common today to perform laparoscopic fundoplications, and hopefully that is what you are planning. The recovery time is much shorter, the amount of pain/discomfort is much less, and the risk of complications are lower when the surgery is done laparoscopically. In short, for most people it is not nearly as tough as an open procedure.

I am curious what the docs are telling you about the cause of the chronic cough. Do you have a problem with aspiration at night? That usually leads to a "smokers cough", even if you don't smoke. It also can lead to flu like symptoms and pnuemonia (pneumonia). If you have been aspirating, the fundoplication should resolve that issue for you.

Also, have you been diagnosed with Barrett's esophagus as a result of the reflux? If so, you will want to continue an endoscopic surveillance program for some time after the fundoplication, even if the surgery successfully alleviates your symptoms. You will want to be sure that there are no further changes in cell structure (assuming you have Barrett's) for at least two or three years after surgery before discontinuing the surveillance program.

Note also that nissen fundoplication is not typically a life-long fix. It has an average useful life, just like heart by-pass surgery has an average useful life. The benefits/efficacy can wear off over time. While each person reacts differently, I believe the average useful life for this procedure is 10 - 11 years. You should discuss that with your GI doc and your surgeon.

Good luck with the procedure. Let us know how things go.

Best regards,
Chicken Soup

[JackieG]

Dee:

There is a pretty good study On Line by the Mayo Clinic, although it is a bit dated (1997). Still seems worth reading. You can access it at:

http://www.dcmsonline.org/jax-medicine/1997journals/september97/reflux.htm

Mayo's results would indicate that the average useful life is greater than 10-11 years (which I sited in my previous response). That's good news, and probably reflects the improvement in the technique since I had mine done in 1991, or the superior skill of the surgeons at Mayo (which would not be at all surprising).

regards,
cs

[jaspur]

If you are in danger of getting Barretts Esophagus from your reflux or your cough means that stomach acid from the reflux is getting into your lungs (and your docs agree) you should get the Nissan. I had it done at Beth Isreal in Boston Laproscopically (which is the way they do 99% of them) and it stopped the reflux.Also I have asked my surgeon and every surgeon that I can come into contact with in Boston  re; the life of the Nissan is forever not 10 years etc. My Nissan is 9 years old and looks the same. I have Barretts esophagus and have to be scoped for life (always every 18 months for life it is a condition that cannot be reversed) and the Doc sees the wrap and it is the same as the day when it was done. Check the forum for the side effects of the operation re Bloating ect... good luck get a surgeon that has done a lot of these...

[JackieG]

Hi jaspur:

Your post makes me wish medical science had evolved a decade or so earlier than it did. In 1991, lapro nissen's were just being introduced in one or two places. I, of course, had the open procedure and had complications that put me in ICU for 6 1/2 days. My fundoplication lost its efficacy gradually after 7 or 8 years, and in the summer of 2001, the original Barrett's progressed to esophageal cancer. I'm aiming at that 5 year target that they use as a marker to proclaim one cured of cancer. One year down, four to go!

Keep up with the surviellance program, and I truly wish you the best of luck. The esophagectomy I had last summer made the open nissen fundoplication back in 1991 look like child's play!

We haven't heard back from Dee, but hopefully she doesn't have Barrett's and isn't having problems with aspiration. At least the surgical options available today are much better than they were 10 to 12 years ago.

Stay diligent!
best regards,
CS

[Bionic Granny]

Hi, I'll be going in on Thursday for my gastroscope to see why I'm having nausea and reflux, even after the nissan done in 2000. We do know that my stomach produces too much acid and I took Prilosec, but started throwing up and stayed with a sick almost flu like stomach. With all the surgeries and the stress, it's possible that I have an ulcer or gastritis. My nissan is still intact on the outside, so now they want to look at the inside. I pray that the acid has not messed it up. I almost did that terrible remedy that was suggested, but thank God for people like you and so many others. I also may be facing surgery #10 in December for some more adhesions. I feel like Tammy Wynette must have felt with the endless surgeries. I'll let you know how things go. My doctor also told me that the nissan is not good for life, in some people, because of acid production. I haven't been checking posts lately, because I feel sick. I first thought about the West Nile thing, because I do live in the south and there have been many deaths here, but I'm too afraid to even ask them about that. I only have flu like symptoms, so should I still ask? Thanks for being such a caring person.

[JackieG]

Did they perform a partial vagotomy when they did your nissen fundoplication in 2000? The sever some, but not all, of the Vagus nerve connections to the stomach that transmit signals to the stomach to produce acid. It is not a total fix, but is an attempt to add to the effectiveness of the fundoplication in preventing reflux problems. If they did not do the partial vagotomy when they did your fundoplication, they won't do a new surgery now to do it.

You should report all of your symptoms to your doctor when you see her/him on the 26th. The more complete picture they have, the greater the chances that they can offer more effective care.

As an aside, I recall from one of your posts some time ago that you were planning on using your doctor's visit on 9/26 to get your doc's opinion about liver flushes. You may want to be sure that both you and your doc's attention are squarely focused on YOUR issues. I did, however, print out one of Hulda Clark's "recipes" for a liver flush that "Patriot 1,2 & 3" used to peddle here. I was seeing one of my docs on 9/12 to get the results of my latest semi-annual biopsy to be sure there is no evidence of the return of cancer (Thankfully, there wasn't). After we finished the business at hand, I gave him the "recipe" and ask for his opinion on liver flushes. He looked at it, laughed heartily, handed it back and said: "That's hogwash, and you can tell your friends on the Gastroenterology Forum that your doc said so." Someone else on this site did the same thing a few weeks earlier (I forgot who it was), and her doc chuckled, and told her "don't waste your money". As far as liver flushes go, I think we've finally proven that 'that dog won't hunt'.

Good luck on the 26th. I hope you feel some relief soon.

With kindest regards,
Chicken Soup

[Bionic Granny]

I went to see my surgeon today and in December, if the pain is still bad, he is going to do another lysis. He did not do anything to my vagus nerve. I'll know something Thursday about my stomach, unless the storm reforms in the Gulf. I have to call them Wednesday to make sure that the test will be done. I'm really a little scared this time, because I've had ulcers before. I'm having my fourth lysis since 1982, because we already know what's causing the burning and pinching. It's not easy sitting, I'm more comfortable standing or lying ---and I can't do that forever. Later.