Doctor insights on:
Best Nissen Fundoplication Surgeons
I'm not from usa, do you think a surgeon should perform fundoplication op on someone with a 24hr pH de meester score of 1. I have many questions?
There is a good correlation between documentation of acid reflux
& demeester score. If the score of 1 is the sole reason provided
as justification for the fundoplication, standard of care would indicate it is not warranted. Of course there are variables not listed. Was testing done while on therapy, etc? ...Read more
Yes: You should get a GI study and make sure it did not failed. ...Read more
If hiatal hernia is causing gerd, why can't surgeon just repair hernia hole instead of doing that and a fundoplication?
Been there done that: Doesn't work sewing muscle to muscle under tension you get early recurrence / failure ...Read more
I had a laproscopy nissen fundaplication last yr but surgery did not go rite and surgeon dicharged me as his patient with no after care av gas bloats
Nissan fundoplication? Best places to go and is it advisable? Or can I get a esophogus replacement?
Depends: I know nothing of your problems or condition here. Surgery is performed when there is expected to be a beneficial result of the operation. I do not know why you might or might not need surgery. Esophagus replacement is a very major surgery usually only performed for cancer of the esophagus. ...Read more
I had fundoplication surgery dec 2011 for my chronic cough. It turns out I had at best (before the surgery) mild acid reflux. My cough was caused by a?
Is cough gone?: A nissan fundoplication is a surgery that's been done for years to treat acid reflux; now, however, it's often done laparoscopically. Reflux can cause cough, hoarseness, wheezing, heartburn, etc. If your symptoms are better, know that even mild reflux can cause symptoms. If the cough persists, it's back to the drawing board. Asthma, sinus infections, and/or allergies are frequent reasons. Lgromko. ...Read more
Yes: Technically should be possible to take down and reverse nissen, even laparoscopically. The important question is why it was done and what the reason for wanting to have it reversed. Talk with your surgeon. A seond opinion may be helpful to assess the problem. ...Read more
Ask your surgeon.: I tell my patients not to lift more than 20 lbs for 3 weeks. It is advisable to avoid very heavy lifting for six weeks. ...Read more
Not common: A nissan procedure is recommended for severe reflux disease or a hiatal hernia that is causing symptoms not adequately managed by nonpharmacologic means or with medications. Because asthma can be caused by reflux, it is possible a nissan may be recommended; but this would be very rare. Reflux causing asthma is more common in children. Long before surgery, many treatments for such a problem exist. ...Read more
After a nissen fundoplication takedown, should the normal esophagal motility priorto. Surgery return?
I'm havin trouble swalowing again, but barium swalow showd no narrowing had fundoplication n april even tho it didn't show narowing I no I need itdone?
Probably ok: It's normal to occasionally have some trouble swallowing, especially after a fundoplication. It also depends if this trouble is manifest with the sensation food or liquids are getting stuck in the throat, or lower such as the bottom of the breast bone. If its in the throat, its not related to the fundoplication, and certainly not dangerous. Ask you surgeon for a follow up visit to check it out. ...Read more
Foregut operation: A hiatal hernia is when the natural opening in the diaphragm enlarges to allow the stomach to migrate into the chest. If a large part of the stomach is involved, it is a para esophageal hernia. Repairing this involves closing the hole to the right size & wrapping the lower esophagus with the top of the stomach (nissen). A tube is placed in the stomach (gastrostomy) rarely in adults. ...Read more
Wrap for reflux: A nissen fundoplication is an operation for reflux. It is usually done laparoscopically. First, if a hiatal hernia is present, it is repaired. The upper portion of the stomach (fundus) is then wrapped around the esophagus forming a 360 degree valve that controls reflux. ...Read more
Operative. ..: Complications include generic things such as infection and, if done laparoscopically, intra-abdominal visceral trocar injury and possible conversion to open procedure. Specific to the nissen fundoplication itself are too tight of a fundoplication, unwrapping of the fundoplication, and gastric bloating from difficulty burping or vomiting afterward. ...Read more
Operative. ..: Complications include generic things such as infection and, if done laparoscopically, intra-abdominal visceral trocar injury and possible conversion to open procedure. Specific to the Nissen fundoplication itself are too tight of a fundoplication, unwrapping of the fundoplication, and gastric bloating from difficulty burping or vomiting afterward. ...Read more
Severe Reflux: A Nissen Fundoplication is a surgical intervention generally performed very successfully for patients with severe esophageal reflux that does not get better with more conservative medical treatments (anti-acids and proton pump inhibitors) and life-style modifications (weight loss, smoking cessation, decreased alcohol intake, smaller more frequent meals). It is performed by a general surgeon. ...Read more
There Aren't Many: There are the usual surgical complications like bleeding, infection, organ injury, etc., and risks of anesthesia like cardiac events and pneumonia. The major complication of the nissen itself would be the failure of the operation to continue controlling reflux in the long-term. This would be especially likely in morbidly obese people, who are better off having a rny gastric bypass for reflux. ...Read more
Why are there mixed opinions on reversal of nissen fundoplication surgery? Is reversal safe, difficult?
It is more difficult: To undo a nissen fundoplcation than to do it. After creating a nissen fundoplcation, it gets really scarred in place. To take it down puts the distal esophagus and gastric fundus at risk for injury. The only reason to consider taking one down is intolerable gastric bloating with inability to burp or vomit afterwards. And you have to consider why the fundoplcation was done in the first place. ...Read more
Will a Nissen Fundoplication loosen (fail) over time? Research on the Internet shows redos are common after 10 or 20 years.
Unfortunately, yes.: Nissen Fundoplications r not a cure-all. Because nothing is removed in this surgery, the effects of surgery do, indeed, wane over time. How fast depends on the patient, their lifestyle, & the skill of the surgeon (among other factors). However, it is better than living thru heartburn in that time (espeically if medications have not worked) bcuz at some pt, damage from acid reflux can be permanent. ...Read more
What are the risks \ complications of converting a failed in tact partial nissen fundoplication to 360 wrap? And what are the success rates? Thank you
Too much to say:
Not enough room to answer this but some thoughts. 1) choose a trustworthy surgeon for these answers. 2) since you say "failed" I assume heartburn persists. Do you still have your gallbladder? Few are aware of this, but undetected gallbladder problems often contribute to or cause persistent heartburn or GERD. Even if no gallstones GB can still be a problem. If U/S of GB no stones, get
HIDA with CCK ...Read more
Would you recomend nissen fundoplication to be preformed on a 4month old, the baby dose not hold down formula at all, and vomits some of the st 2 food?
Yes!: This is the most common anti-reflux procedure, involving closure of the hiatal hernia and re-creating a new valve by wrapping a portion of the stomach around the esophagus. While very effective, this procedure is reserved for the rare patient who cannot manage their symptoms with lifestyle and dietary modifications supplemented by anti-acid medication. An incisionless option, tiff, is available 2. ...Read more
Multiple Ways: A nissen is wraping the loose upper portion of the stomach around the lower esophagus to reinforce the valve that is located there to prevent reflux from the stomach into the esophagus. It also works by bringing the lower esophagus into the abdominal cavity where pressure is greater, furthing reinforcing the valve. Also an hiatel hernia found at the time is repaired. ...Read more
See a Surgeon: Basically, if you have documented reflux disease either by history or testing such as egd or ph probe test, then fundoplication can be considered. Medications can help with reflux, however if you are young or the risk of surgery is minimal, the fundoplication can keep you from needing to take medications for your lifetime. If medications don't work, then surgery can be considered. ...Read more
EARLY or LATE?: Early complications include injury to the stomach, esophagus, or adjacent organs (spleen). Late complications may be due to the wrap being too tight (difficulty swallowing, gas-bloat syndrome) or too loose (persistent reflux). Rarely, nerve injury can lead to diarrhea and/or poor emptying of the stomach. ...Read more