Nissen Fundoplication

[gi-reflux]

How long should I try different medications suggested by my doctor before thinking of a more permanent solution like surgery. I realize that I have had many symptoms over the years that seem to resolve themselves with over the counter meds, but this time they did not. When I finally sought medical attention I realized I had a hiatal hernia, acid reflux, and bile reflux. I also had my gall bladder removed a little over 30 years ago (I was only 19). So far I have tried Prilosec, Pepcid, promethazene, nexium, and now nexium with reglan. Nausea is less, but reflux symptoms remain and I am hoarse with a hacking cough several times a week. The reglan leaves me in a fog and not feeling very competent at work.

[Schell]

I am not a doctor so definitely talk to a specialist. I recently did have Nissen Fundoplication surgery and after 3 weeks I can tell you I am very pleased. Prior to the surgery I was not able to sleep but maybe 3 hours a night and that was in a sitting position. I could not eat or drink anything without getting it coming back in complete form or in acidic form. I couldn't lose wieght and found my energy and health deteriating. My insurance continually changed to where it didn't cover the medications and I was forced to spend alot of money to get even a tiny bit of relief. My primary family doctor sent me to talk to a specialist to see if the procedure would work for me. I figured it wouldn't hurt to check into it to see if it would work. Sure enough, I was the prime candidate and the wheels to recovery from the horrible state I was in started. I will not kid you the first week after surgery is a little painful. I would totally go through it again just to get to the feeling of comfort I have now. Please do go talk to a specialist that specializes in Nissen Fundoplication and see if this is a resolution to what you are going through. They may be able to help. Remember the answer is no if you do not ask the question.

[hcribb]

I had this problem starting at age 9. It didn't bother me too much during my teenage years but has been very problematic in my 20s. I tried all the OTCs, Prilosec (I swear that made it worse), and Nexium. Nexium helped some but I was still not sleeping well and having LOTS of burning pain. The surgery has been well worth it for me and I also have an aunt who had great results. You may want to talk to a surgeon because just talking to them doesn't commit you to surgery. They will do some testing to help you make a better-informed decision.

[Frances]

Hi. Your story soounds somewhat like mine. I just had the "Fundo" surgery two weeks ago. I had been on every medication available for GERD for the past ten years. This past year was the worst of all. The last two months I slept with Mylanta right by the bed along with a bottle of water. I coughed continuously, burned 24/7 clear up into my throat and across my upper chest. I had an EGD in September followed by the series of tests NECESSARY for the Dr. to determine whether you can and should have the surgery. My final test, drinking the Barium, was the clencher. I asked the physician afterwards that had done that test on me if I really needed the surgery. Her explanation was my indication to agree to have the surgery. The most important thing she said was that I was a high risk candidate for cancer of the esohagus. That got my full attention.
Today is my two week post operative date. I am doing well, or as best as I can do at this time. I have and am learning to chew, chew, chew, chew, small bites, small bites, small bites, small bites, small sips of water, tea, coffee, some juices but no caffeine or carbonated beverages. It has become a whole new way of eating "right" for me. I eat several small meals and will stay away from meat and bread like the Dr ordered for eight weeks. The meat I can do, but I love bread....homemade warm bread with butter..........soon!!!!
I had a very good surgeon who took the time to explain everything to me and has been working with me through the recovery from this surgery. I call them often with questions when I have problems and I can say that it was worth it and hope I feel the same way down the road. My prayer has been answered!!!!
Good luck to you

[hcribb]

Hang in there!! After 2 weeks was when I first started to notice a difference...especially when I could finally lay on my stomach (flat!) and there was no burning. I found that it didn't take 8 weeks to get back to regular foods...I just introduced things little by little. They said no PB or bread but at about week 4 I ate PB and jelly dipped in milk and it was pretty good. Just when you try something new, make sure to chew it COMPLETELY and have water close by. It only gets better from here...best wishes!

[misaharb]

I agree with the other replies, you sound like what I went through, really nasty reflux all the time, waking up in the middle of the night coughing (sometimes a little blood) and not being able to sleep the rest of the night. I couldn't sleep on my right side at all, and even trying to sleep semi-upright in the recliner didn't help. This went on for several years until the lovingly given nagging finally got me to my family doctor who prescribed Aciphex (worked for about two months), then close to a year on Protonix. I went to a GI specialist who did an upper endoscopy, doubled the Protonix dosage, and did a follow up endoscopy 6 months later. The damage was reduced a little, but the symptoms never got easier so the decision was made to go to a general surgeon for another consult. He did a barium swallow test and confirmed that I was an appropriate candidate for the procedure. I am not long post-op (only 1 1/2 weeks), but there has been NO reflux at all, and I can lie in bed in any position, something I haven't been able to do for years. If you do this, I would say to listen very well to the instructions on what and how to eat after the procedure, because I overdid it one day and really paid the price (bloating, gas, really bad nausea for the rest of the day). I had it done via laparoscopy, so I was in the hospital only one night. Since my stomach is by nature smaller after the procedure, and since I can't eat very much food each day, I have lost about 10 pounds, and probably will lose more before I go back to a more normal diet. I saw on one post that some people gain the weight back, so I will try to be careful and do what I can to keep it off. (I estimate that I needed to lose 20 pounds anyway so this is a bonus for me!) The best of luck on whatever you decide to do, just ask a ton of questions and follow the directions that the surgeon gives you.

[TexasTen]

Regarding the long string of meds you have tried without success (and I tried without success), my doctor and I finally found that Zantac (Ranitidine) works. 150mg with dinner made an improvement, and 300mg totally relieved my problem. (My problem was waking at 3am with acid burning in my esophagus accompanied by crampy/pressure feeling. When I then sat up for the next hour or two I could feel something sliding down - the top of my stomach going back where it belongs? - and then I would feel OK again.) Also, the head of my bed is now raised about four inches (six inches is probably more effective, but start to get problems with bed clothes and myself sliding during the night, and four inches seems adequate).

I still struggle with mild cramps, gas, acid, indigestion (all in esophagus) every night between dinner and bed time, although I do not have those symptoms after breakfast or lunch (??x#!). I find the less I eat for dinner the better, and I'm moving toward the bland meals recommended for post op. I've lost 20 pounds; that's a good thing, but another 20 won't be.

My doctor is talking about a Fundo and I am sitting on the fence. I feel that Man's surgery can not best Nature's gifts and the horror stories scare me (seems like I'm always in the wrong line at the grocery store and the one who has the bad luck) but will probably have the surgery if he brings up the cancer risk again.

P.S. My doctor presribed Nexium right after I used Prilosec OTC with VERY painful results. Make sure the meds don't overlap.

[Pspinkie]

Hello everyone, my name is Larry and im in Palm Springs, CA. I will be undergoing the surgery in a few weeks. I have been through it all, upper and lower endoscopy, CAT scan, PH monitor. I did not think I had reflux but all the tests showed I was off the charts and the damage is pretty bad. On top of that I am HIV positive for 11 years now and because of my HIV meds I can not take any of the meds for reflux not even over the counter. So with that and the damage that is already done surgery is my only option. Actually I am hoping it will make me feel a lot better.

Met my surgeon yesterday and feel very comfortable with him. Only thing that scares me a bit is he mentioned the slight posibility of a problem with the spleen since I guess they have to detach that from the stomach and then if they cant stop the bleeding they will remove it.....

Anyhoo....any advice or experience would be appreciated. I guess until the surgery I can eat whatever I want since it apprears ill lose a lot of weight afterwards

[TexasTen]

Hi PS

I'm scheduling Fundo surgery also. It sounds like mine will be less complcated; no spleen thing.

I have talked to three doctors who have first-hand experience with Fundo patients (total sum of patients is several hundred) and all three doctors recommend the operation if the meds don't produce the needed results.

Also, when I was sitting on the fence regarding my decision, they advised that I may not be a candidate for the surgery if I wait. The muscles in the esophagus weaken with age (those are my simple-minded words) and one's esophagus might not be "strong" enough for the Fundo solution later in life (I'm 64). We need strong esophageal muscles to push food through the Fundo (I think the term is paristalsis). Also, Barrett's Esophagus might develop (a condition that might turn into cancer), and that can preclude the Fundo.

Pick a surgeon with specfic Fundo experience. If the stomach is wrapped too tightly around the esophagus, three functions will become difficult: swallowing food, burping, and vomiting. "Profound bloating" is one of the many possible consequences, and a surgical redo could be necessary. This results from stitching a little too tightly, so the experience of the surgeon with this particular procedure is key.

All in all, it's reported that about 90% of patients are glad they had the operation. I talked to a woman who was happily back to a normal life (aside from some minor surgical soreness) the day after the operation.

Corresponding with others in my predicament gives me some solace. Hope something in this note helps you.

[TexasTen]

PS to PS:
After a very long string of meds, I finally got Omeprazole 40mG (I think it's super strong Prilosec) and that worked the best. I'm concerned about taking strong meds, but two doctors told me Omeprazole has a substantial track record and is relatively safe. I understand it stops the production of stomach acid (compared to Zantac/Rinitidine which negates the effects of stomach acid after it is produced). The surgeon prescribed it for me to get rid of the inflamation in my esophagus before surgery.