Nissen Fundoplication - Some information please

feelo

Before I start I am not looking for personal medical advice (I understand people's reservations regarding giving out medical advice and I totally understand them). I am looking for some information regarding the Nissen Fundoplication procedure. I am due to get this procedure done in the coming months to correct acid reflux. Can anyone tell me the approximate success rate of this procedure? I have read that they're are possible side effects after the proc. like inability to belch, vomit, and bloating. If you are ill they're are times when you need to vomit! Also, the one thing I don't understand with this procedure is the fact that the sphincter muscle or valve at the opening of the stomach is tightened. If reflux is caused by over production of acid then are you simple containing the excess acid within the stomach? Is reflux also caused by the sphincter muscle not working properly? I had two tests done that determined my eligability for the proc.: a manometry and a dual probe ph test. Does the manometry determine if the sphincter is working properly and preventing acid from exiting the stomach? I am a bit confused about the reasoning behind the operation, I can understand its use if the sphincter is not working but if the problem is due to excess acid production then are just simply plugging the hole and not dealing with the real problem.

I would appeciate and information that would help enlighten me with regards to this procedure.

Many thanks.

admol22

Hi, I had this procedure carried out a couple of years ago. The surgery attempts to improve the function of the sphincter to stop acid from the stomach passing easily into the oesophagus. If a hiatus hernia is present this is normally also repaired. The procedure does not dramatically reduce the amount of acid produced by the stomach. My personal experience with the procedure was not good. Like you I had the gastroscopy, PH tests, manometry and other procedures. I was told that my acid levels were horrendous and that I would be an ideal candidate for nissen fundoplication. The days after the surgery were very uncomfortable and at times extremely painful (so much for minimally invasive surgery). I could only take liquids for about a week and then very soft foods for another 2-3 weeks. I found it difficult to belch and had severe cramps and discomfort. I had been told that this might occur so I wasn't too concerned about it. No-one warned me however about the explosive bouts of diarrhea or the severity of the stomach cramps. Also eating even small meals could leave me in agony. I gradually came back to a more "normal" diet over the following 12-18 months. The severe cramps lasted for over a year and I lost a lot of weight. Now after 2 years my diet is almost back to normal and my weight has increased a little. However the reflux is back with a vengeance and I am taking more antacids and proton pump inhibitors than I was before the surgery. I personally could not recommend this procedure, however a lot of people do very well after it with very few problems. I think you should talk very carefully with your doctor and consider if other changes in your lifestyle or diet may be more beneficial to you,
best regards and good luck,
admol22

feelo

Hi Admol22, Many thanks for your reply. I'm very sorry to hear that the procedure hasn't worked out for you. It must be very dissappointing to go through all the hassle and not feel better. Like you, following the tests I was told my acid levels were very high. I'm a bit worried myself about going through it and only making things worse. Have you ever tried using a nutritionist to help you with your diet? I have tried diets myself before but they haven't worked, I am thinking of seeing a nutionist myself before I do the op just to see if I can fix the problem that way. If that doesn't work I'll go ahead with surgery. I often think that it has to be something to do with my diet but maybe I just have a dodgy sphincter or I just over produce acid. The procedure is a bit unusual all the same as it doesn;t stop over production of acid. Did the ppi's control your symptoms before you had the surgery?

admol22

Hi, one of the main reasons for having the surgery was to reduce my dependence on PPI's (which do significantly reduce the amount of acid produced - though they are expensive). Dietary changes had no appreciable effect on my acid levels and since the surgery the list of foods that I know I have to avoid has grown. I cannot drink alcohol, white processed bread is a big no-no as is most red meat and any spicy food. Sadly these days everything I eat gives me reflux it is just a matter of avoiding the foods that give the biggest problems. Trying to be objective I feel that the surgery was definitely not worth the pain and discomfort and as I have already mentioned my symptoms in the past few months are as bad if not worse than before. I do however personally know a number of people who have had this surgery with very good results, I just feel you should explore every other option through diet/lifestyle change before you go through the surgery, discuss options thoroughly with your medical advisors,
regards,
admol22