Reflux, oesophagitis and nissen fundoplication surgery

[grannyjogger]

I have had a hiatus hernia for many years and GORD. A gastroscopy three months ago showed Grade C oesophagitis, 6cm sliding hiatus hernia and diverticulosis. I have taken Lanzoprazole (one or two 15mg daily) for about 10 years. Following gall bladder removal last year I also have bouts of bile reflux. My meds were increased to 60mg Lanzoprazole for a few months, then 300mg Ranitidine was added after my first gastroscopy and a month's course of Sucralfrate 20mls daily. I then had an appointment with the gastro surgeon who recommended nissen fundoplication surgery. She explained some of the issues that may arise post surgery, including those that may not be temporary. I was referred for manometry and pH monitoring tests. I had to stop all meds for the week before the procedure and I had so much projectile vomiting that after four days I ended up in A&E with confusion and dehydration and was put on a drip. Had the manometry this week but I was so sick that the catheter came out when I got home and vomited violently. That was four days ago and I was told to go back on the meds until another appointment could be arranged, fortunately the sickness stopped quite quickly after the first few doses. I had a follow up gastroscopy today and was told that the increased meds that I've been on for the last few months have not resulted in any change to my oesophagus (although the consultant did say there was a marginal improvement but it was still Grade C). I have started using self help measures - wedge pillow and modifying my diet which is working well. I need to lose about a stone in weight and am focussing on that now. I was really disappointed that in the 12 weeks between the two gastroscopies there has been no significant improvement. I feel that I am heading for the nissen procedure, although I had hoped to avoid this.

Can anyone share any experiences of nissen fundoplication surgery? I would be really grateful to know what issues people have had after surgery, particularly long term problems.

Thank you.

[rayw55]

Hi, please remember that like investments past experience is no guarantee of future results, but, your story is very similar to mine, I started in the same way when I was only about 27, after almost 13 years of this slowly getting worse I eventually had a fundoplication when I was 40. That worked very well to begin with for about 5 years and then my symptoms started to return even worse. During this time I had regular endoscopes as I was diagnosed with Barrett's oesophagus. When I was 50 I was diagnosed with cancer and had Ivor Lewis operation, I am now over 7 years post op and am doing very well. I guess my point is that to have advance knowledge of what may happen is good but each of us is different, after my fundoplication I only had a few weeks off work completely (I was in the services at the time) the results at the time as I say we're excellent, pain from the op was ok, and recovery to work normally was fairly quick. I know others for whom the fundoplication didn't achieve much but personally I think that we should take whatever action is needed to improve any possible outcome so my suggestion would be to trust the surgeons, they do not advise surgery lightly. I hope this helps in some way and is some way towards what you wanted as a response .

[grannyjogger in reply to rayw55]

Thank you rayw55 it is helpful to know that recovery from the fundoplication was positive. One of the complications for me is my autoimmune disease and the impact that has on my body's ability to heal. This was evident last year when I had cataracts removed last year and had months of inflammation rather than the expected few weeks - inflammation is a huge issue for me which is why I am so wary of surgery.

People's feedback is really useful. Thanks.

[gutlesswonder]

I apologise for complicating your dilemma.

A skillful Nissen ( not too tight not too loose) should cure the hernia and improve (but not cure) your reflux however it may be dawning on you that, perhaps the major component with the oesophagitis is bile and not acid? At grade C healing may thus be beyond reach, particularly given your cholecystectomy. Thus the path towards Barretts and maybe worse is well nigh inevitable.

The experience of rayw55 is instructive - he was comparatively young at the time of his first procedure.

It is very drastic but would it be worth considering an oesophagectomy now rather than having to face that some years hence when you may be considerably more frail?

The determinant will be your age (63?) and level of fitness now (your autoimmune syndrome). The stomach reduction and pull up involved in the Ivor Lewis procedure would also have the virtue of shrinking the area of acid production.

Your self help efforts are spot on.

Has the cholecystectomy resulted in bad diarrhea?

[grannyjogger in reply to gutlesswonder]

Hi. No diarrhoea at all since the cholecystectomy. The only ongoing issue seems to be the bile reflux and that is becoming less frequent - only about once every few weeks.

[Hidden]

It is fairly unusual for hiatus hernias to be repaired, and if your surgeon has recommended this, I think it is fair to say that it will be the best option for you. The more serious hiatus hernias do need to be sorted out to prevent further even worse problems in the future.

There are a surprising number of people who have persistent reflux who do not respond to PPI medication, and some other treatment eg surgery becomes the best option because exposure to reflux long term is a health risk in itself.

I think that the surgery may well be done laparoscopically (ie keyhole) these days and you might have a couple of nights in hospital. You may well find that swallowing, burping and possibly vomiting might be different but these really are things the surgeon will explain because it will all depend on your own circumstances. I think you would be fair to expect a significant improvement after a few days recovery.

[grannyjogger in reply to Hidden]

Hi. I met with the surgeon a few weeks ago. She was very open about what I should expect and that included the inability to burp and to vomit. When I asked how long I could expect before this improved she said it would probably be permanent. As I don't have any control over when the bile appears this is a worry. A good diet goes a long way towards controlling excess acid but the bile comes out of the blue. I'm now keeping a food diary to see if I can identify any patterns.

[Minardi in reply to grannyjogger]

May i ask how you know the difference between the bile refluc or acid reflux?.

[grannyjogger]

Hi Minardi. The consultant asked me the same question and this is what I told him. I have had acid reflux for years and very typically that presents as burning in the upper chest and works its way up into my throat. When I have problems with bile the discomfort starts lower down I n my stomach and invariably results in actual vomiting. There is a distinctive taste and colour to the bile. It is extremely bitter and usually is greenish yellow/brown in colour. He agreed that the bitter taste was more likely to be bile reflux. I have had acid reflux for many years. The bile reflux only started last year after I had my gallbladder removed and it feels very different to the familiar acid.

[Minardi in reply to grannyjogger]

Many thanks granny jogger for your reply. My symtoms stated only 6 months ago, so i dont know the difference. My findings are the 3 different types of ppi the doc has given are not working at all. so i am now thinking bile refux. My journey with this is all now starting. My endoscopy looked like early barretts stages , waiting biopsies results. I wish you all the very best and will keep a look out for your posts in how your progress is

[grannyjogger in reply to Minardi]

Good luck Minardi, I hope you get the diagnosis sorted out so that you can get some effective treatments.

[1960finas]

Hi my Daughter was on waiting list for this she's now been taken off the list not on any medication Drs were asking me how I done this please message back

[1960finas]

Hi I sent a reply 3 day's ago,does it not interest you I'm trying To Help people but no one is getting back to me