Fundoplication Reversal

[Gastroboy]

Hi everyone, I'm trying to find out as much information as possible on having fundoplication surgery reversed.
I had this surgery not so long ago. Without going into too much detail a series of events and mistakes made by myself and others led me to believe that having this surgery would be a good idea. My reflux wasn't that bad at all really and the medication was working well.I had a small sliding Hiatal Hernia so I still had occasional reflux on the medication but it was more like a gas with no acids or liquids really and all of my other symptoms had gone despite not taking my diet and lifestyle changes that seriously.

Now I'm sure this surgery helps a lot of people with severe reflux that cannot be controlled well with medication and lifestyle changes but I have to say that in my case all of the complications or side effects associated with the procedure are 50 times worse and harder to live with that what the surgeon described to me himself after reviewing my 24 hr PH study as mild reflux.

I'm very keen to have this operation reversed and would love to here from anyone anywhere who has managed to have a full reversal. I would love to know if the bloating and abdominal pain has gone or improved. if you can burp freely whenever you need to ( something I totally underestimated the importance of in my case ), if your bowels have improved and if your reflux returned any worse than before having the operation.

Also I live in Australia, so if anyone down under has had this operation reversed or is looking into it please help me out with any information you may have.

I feel this operation is being marketed by some practitioners as a convenient thing to have done to avoid taking medication each day. Something I have learnt the hard way and wish someone had said to me is this operation is a big deal and the recovery time can be very long. Take your diet and lifestyle changes very seriously and only consider surgery if your reflux is bad and when you have tried every other option available with no success.    

Thank you,
Gastroboy.  

  



              

[Dolphin1]

I have suffered so much emotional stress from my first surgery and the doc trying to tell me I was ok. I dealt with it for almost a year before I made a 7 hour trip to Cleveland Clinic to see a Dr. Thomas Rice who in his words said my surgery was ONE WEIRD MESS!! He took it all down and put it back and said it was so messed up most surgeons would have just taken it out.  I was stuck on a feeding tube for 10 weeks , have been through 3 major stretch procedures and can finally get some foods down like oatmeal ,etc. However I lost 50 lbs and 35 inches, and still even when I get food down , it goes straight through. Nothing wrong with my colon so they think the first Doctor damaged my nerves during his messed up surgery and I may be stuck with that for life . I live off Ensure now to stay as well as I can but go back on Feb 4th for another evaluation from Dr. Rice to see if he can make it better or I live like I am as long as I can or stuck with a feeding tube for life. It stinks and the first doctor make it sound like a piece of cake. I can only say I wish I had went to Cleveland first, Dr. Rice told me this surgery should NEVER be done laposcopic!! It is way to major so how are these DR.s getting away with this??

[Flycaster305]

As fundoplicationshurt reminds us, no surgery is without risk.  Cutting the Vagus nerve was one of my biggest worries and I certainly asked the surgeon prior to engaging him to do my Nissen Fundo work if he had any history about cutting the Vagus Nerve.  He had done over 100 procedures with no Vagus Nerve issues, and like Smiley, it was a hugely successful procedure.  That said, when I had another emergency surgery to repair a bowel blockage, that possibility was presented to me prior to the surgery.  When I had a pacemaker inserted I was alerted that the leads from the pacer into the heart sometimes creates goofy symptoms.  Prior to my heart bypass surgery, the Vagus Nerve issue came up as a possible complication.  
I feel it is a risk/reward situation when we agree to invasive surgeries.  In my case, the presence of a Barrett's Esophagus diagnosed trumped  the less that 100 to 1 chance of cutting the  Vagus nerve.  Studies show over 90% of patients  who have the NF procedure consider the procedure successful, but certainly, any time we agree to either holistic or invasive procedures, we make a choice and have to accept the consequences.

I agree with fundoplicationshurt completely, there is a risk... but developing an active cancer because of Barrett's pre-cancer tipped the balance for me to having the NF, and in my case it was a good choice.

[Imajerk]

I'm taking fundoplicationshurt VERY seriously. My GI doc has spoken to me about how to monitor barrett's and that there are procedures today to address it, if you get it. I don't have it but I do fear it.  I have a HH with GERD that is acting up in a way it previously did not. Sour taste in throat each night, and now this morning. Have been restricting diet and taking Rx meds, but so far, still having this problem.

When I was speaking once to a lovely lady active on a breast cancer forum, because I was scheduled for a breast MRI ( came up clean - hope it stays that way), she reminded me that forums tend to be full of the people who are worst case scenarios. The ones with good outcomes are out loving and living their lives.

That's nothing against anyone here, good enough to help others. However, I do notice that despite situations where people do better with these operations ( I personally know someone who had a Nissen because her HH came too far through her diaphragm - she was eating BBQ with my group! whereas I avoided it), we hear a lot of the worst here.

So glad that Flycaster305 was here to give us some good news, and the objective points about risk. Granted, it's easier to do so when you have the good outcome. And in stats, SOMEONE has to be the unfortunate one. Look at all of US! IT's not like everyone gets bad GERDs, so we're in a minority already.

Still, I have to say if I were in dire straits, at threat of bad Barretts, or plagued with esophageal ulcers or at risk of losing my voice, I'd have to consider it, do my due diligence, research the crap out of the options and cross my fingers.

[Smiley2000]

Hi there,

I have read your post and I understand where you are coming from, but I had a very successful Nissen Fundo done earlier this year and now I don't need to worry about my Barret's so much.  I'll go for surveillance endoscopies 1-2 years apart, but my symptoms have improved and I don't have to take 80mg Nexium a day since I've had the operation.

I had a lot of tests done and seen a lot of Specialists before I agreed to the operation and that definitely makes a big difference in the outcome.

[fundoplicationshurt]

DO NOT HAVE THIS SURGERY UNLESS IT IS LIFE OR DEATH; BUT IT CAN BE TAKEN DOWN:

My name's Jason and I had this operation 9 years ago.  What you are talking about is not called a reversal, it's called a "take-down".  It can be done.

You can be permanently disabled from your first fundoplication like me.  Performing a laproscopic or open fundoplication inherently puts your Vagus Nerve at risk of being severed, meaning even in the hands of a surgeon with thousands of operations it COULD happen.

If it does, you will either have a stomach that is paralyzed or diarehha, gas-bloat, nausea, incontinence for life.  Vagus Nerve tissue that is severed CAN"T be reconstructed; like a spional cord injury.  So, whatever's gone is gone, probably for good.  (Think of Christopher Reeves in his wheel-chair.)

The drugs that treat this are getting better by the year.  There are also new proceedures being developed to treat this which are getting better; including a transoral incisionless fundoplication.  If you are considering having this operation you NEED to talk to your doctor and your surgeon about what will happen if they inadvertantly sever your Vagus Nerve.  If they say that won't happen, FIRE THEM because in a malpractice case the expert witnesses will likely say otherwise.

The ONLY people who should have this operation are people who are nearing a life-or-death point.  Living the way I did for the past decade is no way to live.  My life was devastated by this operation.  I'm on disability.

Worse, my fundoplication is breaking down after 10 years.  Eventually we may have to surgically alter it; which for me would be a "take down" as I won't do another.  That puts me at huge risk because one side of my Vagus Nerve still works.  If we sever it I then will live being fed intravenously with a i.v. bag behind me... forever.

Also, an earlier post is correct.  There are surgeons I've read from who write that a fundoplication should be "taken-down" prior to revision because it is the best way to avoid paving over unknown structural problems from the first fundoplication.

I am aware of a few patients in Europe who had their fundoplications taken down and did well.  You will struggle to find surgeons in America who will do it because they're likely afraid they'll get sued.

So, unless you already have a Barrett's patch my advice as a survivor of this operation is DON'T do it.  If you think the pain of heartburn is insufferable you have NO IDEA what evil could lie in wait when one of these fundoplications goes wrong; which it frequently does.  If you don't have the operation, you thus won't need a take-down.  

Dying from esophogeal cancer caused by long-term GERD is awful; but waking up in your own excrement, pelvic floor dysfunction, diarreah, bacterial c. diff infection, permanent gas-bloat, problems swallowing for me are worse.  I write this because I want nobody else to suffer my fate.

[Smiley2000]

Hi there,

I am fully recovered from the Nissen Fundo and all the bloatedness and IBS symptoms that I had earlier have resolved and I feel great :)

I just still have the Chricopharengeal muscle problem (damage from severe longstanding GERD) and still waiting for treatment for that (on waiting list for Botillium injection into the muscle) and it is not a longterm solution and ultimately I'll have to get a Myotomy in about 12 months or so... not looking forward to that as I've had a neck-fusion last year (C5,6,7) and they have to enter the same site to do the Myotomy!!!

Sorry to hear that you still have problems.  As I've said earlier:  I really think you should seek the opinion of a new Surgeon and consider the "Topet/Partial Fundoplication" as the Doctor/Expert here has suggested.

Thinking of you and looking out for your updated posts :)

[dkawulia7]

Hello did you ever go through with the CPM Botox for your remaining throat Symptoms? I know it’s been years since this post

[Christopher R Watters, MD]

From the surgeon side I feel compelled to make a few comments. There is not one form of fundoplication but several different ways of doing the procedure. The goal is to restore the normal anatomy of the esophagogastric junction. More specifically, it is the angle of His that is restored. The Nissen fundoplication is the most popular fundoplication procedure done today and represents a 360 degree wrap. The specifics of how this is done was worked out 30 years ago by Dr DeMeester who performed huge numbers of these procedures and applied several small variations in how tight to make the wrap, how long to make the wrap, etc. The way the procedure is done today is the best compromise between these factors. I say compromise because roughly 5% of patients have an undesirable result. These are evenly divided between those where it works too well or not well enough. If it works too well, the valve is too competent and patients are unable to burp and expel swallowed air. The problem is that if you change the variables on the operation you can reduce either the too good or the not good enough group but you will increase the other hence the best compromise. It is not that the surgeon "made it too tight" as was stated in an earlier post. When this is the case, a revision is typically done to take down the 360 degree wrap and convert the Nissen fundoplication to what is called a Toupet procedure which is a 270 degree wrap. This is also used in patients with altered esophageal motility.
My other comment is to the original post. If the reflux was well controlled medically there wouldn't be an indication for surgery. Why did they recommend surgery in the first place?