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Fundoplication Reversal

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.  

  



              
45 Responses
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329165 tn?1515471990
Hi there,

I read your post and really have sympathy for you.  I have friend who needed another Nissen Fundo after her 1st Surgeon also wrapped it to tightly (stenosis) and she is now 4 months post-op and doing great!

90% of the Nissen ops are a success, 1st time around.  Unfortunately there are still Surgeons out there that do the wrap to tight and those patients will need a re-done.
Helpful - 0
Avatar universal
Hi LadyMBA,
So so sorry you have been one of the unlucky ones in regard to this operation . How long ago did you have the surgery done ? Was your reflux very bad to begin with ? I feel there needs to be some legislation put in place to make sure that the correct testing and procedures are followed before this surgery is   considered. There are a lot of stories online and unfortunately for everyone some surgeons don't seem do all of the testing before operating.        

I haven't visited or posted on this or other reflux websites for a while now. I found a new surgeon that basically confirmed to me that the problems I have been having are indeed due to my surgery and in fact can be quite common problems with this surgery if your unlucky - unlike the surgeon that did my operation who insisted that all of the problems I was having were nothing to do with this surgery and must be because of somthing new !

My symptoms have changes somewhat, my bowels have settled down, my main problems are the nausea, bloating and feeling faint throughout the day. My new surgeon booked me in for a gastric emptying study right away - it showed I have slow gastric emptying and motility problems. I was put on medication to speed up my gastric emptying, it helped greatly with the bloating and nausea but it can have some bad side effects - in my case after some time making me very very sleepy and giving me depression. I have been off the medication for a few weeks now and mentally I feel good but the nausea / sickness is back along with some bloating.

I feel pretty sick every morning, sometimes it improves after a couple of hours and other times it lasts half to most of the day before improving. I still get spells of it throughout the rest of the day but its not constant. I go to see my new surgeon again soon to see what else we can try.

My nausea and bloating is being caused by the slow gastric emptying that is probibly caused by vagal nerve damage or over stimulation. My stomach doesn't move the food through my system quick enough anymore, it sits in my stomach and ferments causing the bloating and nausea. I have been told that things might improve somewhat given more time. Apparently the vagal nerve runs through the wrap area and bloating and scar tissue can over stimulate the nerve causing you to feel faint etc ?

Some things I have found out the hard way, if your not getting any answers from you current surgeon take all of your test results and find someone that is interested in helping, this is hard I know as a lot of surgeons don't want to get involved in another surgeons mistakes.

Have you had a gastric emptying study done maybe your nausea has something to do with slow emptying also ? I feel for you, when things go wrong with this operation it can be very hard to to find out what is going on and the correct path forward.

Keep pushing for the answers, I know in my case I was just so pleased to be told by someone exactly what was going on, after being fed so many lies from the surgeon that did my surgery.  

Gastroboy.                
Helpful - 0
Avatar universal
Hi Smiley2000,

How how are things going ? Hope you have recovered fully now.

Cheers,

Gastroboy.
Helpful - 0
2827584 tn?1340579696
MEDICAL PROFESSIONAL
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?
Helpful - 0
329165 tn?1515471990
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 :)
Helpful - 0
Avatar universal
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.
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