Fundoplication and alternatives

[lookingforward]

Hi,
  I have had severe GERD for the past 9 months which I'm not responding to medication for. I'm now on Omeprazole 80mg daily but no improvement. I had an endoscopy earlier in the month which showed the whole length of my oesophagus inflamed from acid. I have tried every dietary and lifestyle change imaginable, and I'm not a smoker, not obese and don't drink alcohol. I can imagine that the next step will surgery, but I have something of a phobia of general anaesthesias. I had one years ago and it was a bad experience and swore I'd never have another, until the recent endoscopy where I had to have another (they refused to do it under sedation because I'm a nervous patient and they didn't think I'll be able to swallow the tube). Anyway, I'm quite traumatised by the whole thing, and can't see a way forward in terms of treatment. To me, I would rather have major surgery under sedation with a local anaesthetic, but I'm told that the laparoscopic fundoplication is impossible to do that way because instruments need to be inserted through the mouth and into the oesophagus. Does open surgery need to do it this way too? I also don't like the idea of the fundoplication at all, the risk of further dysphagia is a serious concern for me as I have been struggling with swallowing the entire time I've had this. I also don't like the failure rate between 5-10 years and the fact that many people have to remain on PPI's. If PPI's don't work for me now, they're not about to start working after the operation.
  I've heard of something called the Hill Repair, which is reported as the most natural way to help GERD as, although the operation is more complex, it allows the patient to burp and vomit normally and there is less risk of dysphagia and higher long-term success rates. Could you please advise me, is this a procedure that also has to go down through the mouth, and how do I find out more about it? I'm in the UK but can't find resources online to see where this is available. Thanks

[Kevin Pho, MD]

The Hill procedure is a surgical technique to treat GERD, focusing on the gastroesophageal valve.  It can be done open or laparoscopically.

Either laparoscopic and open surgery is done in general anesthesia, so you won't feel if there are any scopes that go through the mouth, or the insertion of any instrumentation.

There are a variety of newer, endoscopic options to treat GERD.  This includes  submucosal sewing/plicator devices.  

These options can be discussed with a GI specialist as well as a general surgeon.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[lookingforward]

Thanks for your reply, but I think you misunderstand my concern. I have a phobia of general anaesthesia and don't think I can go through with another, I am desperately trying to find out if there are any procedures such as the fundoplication or the hill repair that would enable me to have the surgery awake/sedated. Sewing/plicator procedures have such a low reported long-term success rate that I don't think it's worth considering.
Thanks for any information.

[dachsie54]

Hi,
My Gi diagonsed me with Barretts and says it was so small it was hard to tell. He say not to worry, stay on the meds and see him in a year. But my PCP after seeing my results says I have 2-4yrs to live, Help! Two drs with conflicting reports. Ilike my GI but he is so busy, also an ER doc at two hops and barey remebers what he puts me on. He has had me on Calcium channel blockers for years and now I find out they can cause severe Gerd. What can I do? Any help would be appreciated. I will be going for a second opion in three weeks. I live in Boston , also.