Share your experiences with GERD surgery

My brother’s been suffering from very bad GERD for several years now.

He’s tried most of the medications available to treat symptoms, is incredibly careful with what he eats and drinks, and has jacked up one end of his bed a long way, but to no avail.

Next step is GERD laproscopic surgery. He’s been recommended for Nissen fundoplication.

Has anyone had this or other procedures? Would you care to share your experiences here? How effective was it? Any complications? Any medics care to give their opinion (note: does not constitute advice).

Also, though he’s tried most things, but if there’s some alternative treatment that’s cured your GERD, even including insane new age things like putting your chakras through a dishwasher filled with crystals and homeopathic soap powder, please feel free to post your experiences too.

I’ll be sending him this thread.

Thanks!

Khadaji can tell you tales of what happens when it all goes Very Badly :frowning: but I know others here have had much better results.

One thing that is not quite in the chakra / dishwasher realm, but: what other medications is your brother on? I started an ACE inhibitor medication for blood pressure, about 18 months ago. These have a dry cough as a known side effect - and sure enough, I developed one… but the cough behaved EXACTLY like a GERD-induced cough in many ways (like the throat sensation started up the minute I’d lay down, much worse if I’d had something acidic in the evenings, etc.).

It took several months of stopping / starting the medication, a number of stomach-related tests, massively increasing my Prilosec, and my finally saying NO to the damn drug - and the symptoms went away.

Now I’m back to my standard garden-variety GERD, a normal dose of prilosec, and no coughing.

So anyway: other meds can aggravate or mimic GERD so it’s worth checking out.

I have copied and pasted my response to FloatyGimpy’s threada week or so ago and added some detail. I’m a little reluctant because I don’t wish to alarm you needlessly and I talk about it so much already that I always fear that the dopers are way bored of it. However, here is the tale:

I suffered GERD all my adult life. I would wake up choking on my vomit and then I would hack and cough and eventually empty my stomach. (It would have been easier if I just emptied my stomach each night before going to bed, but made me feel like I had an eating disorder.)

In 2003 I was operated on for a hiatal hernia. They performed a fundoplication.

In my case, the esophagus was too short. Since they did not spot this, they did not operate correctly. The operation made things much worse. In the first two days the sutures burst and they operated again.

After I was released (24 days in ICU) the hernia came back almost immediately and even emptying my stomach would not permit me to sleep (I would wake up choking on my stomach contents.)

John’s Hopkins wanted to take out my esophagus and stretch my stomach up to the top of the throat, forming a faux esophagus. That might have worked, but it sounded nuts to me. I now wonder what my path would have been like had I allowed it.

Hershey didn’t *refuse *to operate, but they did every thing they could to talk me out of it. I didn’t want to be on the table with someone whose heart wasn’t in it.

Finally Geisinger Medical operated in 2004 and I was good for about a year.

In May 2005 my stomach just stopped working. Nothing would go down. I’d fight to put a quart of gatorade in me to try to stay hydrated. I was actually convinced that I was probably going to die. I was losing a lb a day and in June 2005 my stomach perforated (tore itself open.) (I begged God to take me home, it hurt so bad!)

As best as I remember the explanation (remember throughout this tale that a lot of the time things were explained to me when I was on heavy pain meds. It would not be far fetched to find that my technical details are inaccurate - but I do tend to write everything down, even when on pain meds): They take part of the stomach and wrap it around itself to prevent the GERD. In my case, part of the stomach had worked its way up through the wrap and the wrap was strangling it, eventually so much so it caused it to pop.

The result was emergency surgery that lasted 10 1/2 hours and I came close to passing-on more than once.

The stomach couldn’t be saved, and they took the stomach out of the pipeline and now my esophagus is attached directly to the small intestine. It isn’t too bad - I can’t eat regular meals and instead have to graze all day - but at least the GERD is gone. It is kinda fun when I have an upper GI, because it always freaks out the techs. (Actually, after the first few times I started to warn them.)

After that, I had several hernia operations and then finally, in 2006, after loops of small and large intestine found their way up into my chest cavity, they performed my last operation.

It makes me a little sad that, no matter how much weight I lose, I’ll always have a big bulge right under my rib cage where the mesh holds in my guts (it looks like I have a very high riding beer belly) but it better than the alternative. I have a neat little titanium bolt in the V of my rib cage where they tied off the mesh and I have an ugly off-center faux belly button that they made because they cut my real one out. (It is off to the right and I kind of think it would look - well, no worse - if they had just left me without any belly button.)

One thing: be sure ask them about Barrett’s.

jjimm, this is an ugly tale, but note that my case is uncommon. Many thousands of successful fundoplications are done every year. This is a known procedure and very common.

Besides my esophagus being too short, I believe that my first surgeon was not competent. Be sure to note that I cannot prove that. I did hear (from a nurse who worked at the hospital - I met her at a bar) that he was forced to retire due to faking some of his certifications and a higher-than-acceptable mal-practice suit rate. (Not the most reliable of sources, as we were both a little drunk.)

In my experience, this too is rare - I have had a great many great doctors. (And even more wonderful wonderful nurses!) Even had he been competent, my current surgeon tells me that my problems are rare enough that it would be easy to overlook unless you had experience with such things.

::shrug:: Competent or not, he did miss it and bad things did happen - so all I can do is live with it.

My current surgeon, the one who saved my life, had suggested Bariatric surgery, rather than re-do the fundoplication. Although I needed to lose weight, I was against that, even though he was 100% convinced that it would fix the problem. As I said above, I often wonder how my life would be different had I allowed that.

That’s my tale - but I’ll end with this: from experience, laproscopic surgery is just about as gentle as a surgery can be. I expect your brother will be up and around the next day - really. And I also expect his life will be better for the surgery.

Coincidentally, I am at home recovering from this exact operation a week ago today.

So far, so good, I spent three nights in hospital (normal is two, but I have a couple of complicated blood conditions that messed up my blood count, so they kept me in an extra night for just-in-case) but was able to get up and go to the toilet the evening of the operation. There has been some post-op bruising and the sutures are still tender to the touch; my insides feel “stretched”, like a muscle unused to exercise, and it took me two days to be able to sit up without assistance. Bending over still hurts if I don’t watch it. I’ve lost 5 kgs already thanks to the inability to eat too much or too quickly or of too much substance.

There has been no heartburn since the op, but my GERD was much less severe that your brother’s or Khadaji’s - I was controlling it with meds, but they were getting less effective and then I spoke to a colleague who left the op too late and has permanent damage as a result and thought “the way things are going, I’m going to have to have this done at some point, it may as well be sooner rather than later.”

So, it’s early days yet, I have a post-op consult with the surgeon in a week, but if there is anything else I can tell you, let me know…

Grim

I had a lap nissen ten years ago.

Obviously, at this point, details are fuzzy, but I do recall a lot of pre-op testing and examining - things like barium swallows to visualize the internals, manometry and pH sampling. The last two were fun… 24 hours with a rubber tube snaked out through your nose to a holter monitor-like device.

Before the surgery, I went through nearly one bottle of Mylanta a day, and would not go ANYWHERE without at least two rolls of Tums in my pockets. This included “to the bathroom” and “to bed.” This was on top of regular diet of Tagamet and Prilosec and regular battles with the insurance company that didn’t want to pay for it.

IIRC, my surgery was at 4 PM or so. At 7:30 the next morning, I was chasing my surgeon down the hall and asking to go home so I could get some rest. (Hospitals are such lousy places to get any rest and recovery.) It was literally overnight to go from eating antacids by the handful to not needing any at all.

The only complication I’ve had took nearly ten years to manifest, and I’m not convinced it’s necessarily related to the surgery - I’ve had a couple run-ins with “steakhouse syndrome” or dysphagia, where a swallowed lump of food does not get into the stomach. The first time it happened, I needed emergency intervention followed by a few days of a soft diet to let the esophagus and cardiac sphincter relax. Fortunately, I’ve since learned the early indications and have been able to manage. Mainly, just remembering to chew thoroughly and not swallow anything large is all that’s needed.

Thanks so far everyone.

Mama Zappa he’s otherwise very healthy and fit, so I suspect this isn’t being caused by another condition. I think our grandmother (and possibly aunt) had hiatus hernia, so I’m wondering if there’s a genetic component.

Khadaji, I’m so sorry you had to go through that. It is a horrifying tale, but I hope my bro will interpret it as misdiagnosis and mistreatment. And that your hernia was so big that the stomach had fused to the heart sounds like your condition was pretty unusual. Is that a fair analysis? Glad you’re in a better place now.

grimpixie how’s it going for you now?

gotpasswords he already eats fastidiously slowly and thoroughly, so ‘steakhouse syndrome’ isn’t going to be an issue, I suspect. He’s also vegetarian so big lumps of sinewy protein aren’t going to be present in his food either.

One of the concerns he has is the inability to vomit. Can people who have had the op burp either? Are there ways of coping with it if the body chooses to expel but there’s nowhere for it to go?

Oh, I can burp with the best of them. From what I understand, it’s a factor of how tight the “wrap” is, and if gas bloat becomes a problem, there are reasonably non-invasive ways to stretch the wrap.

However, it’s true that i can’t vomit. This has only been an issue once or twice in the past ten years. It was unpleasant - your body goes through all the motions, so to speak, but nothing comes out. Does your brother often need to vomit, or are they just concerned about it?

Yes, IMO it was both misdiagnosis and mistreatment. I honestly believe that if my current surgeon had been my first, my life would be different. But who knows, eh?

At the time, when I had the wrap, I had no trouble either burping or vomiting.

Best of luck with your bro’s surgery. My grandmother had GERD her entire life, but instead of treating it in a timely manner, she waited too long and ended up with an erosion. It morphed into esophageal cancer (which I understand Christopher Hitchens has now too), and she died within 6 months.

So that’s a potential side effect of NOT having the surgery, if that makes you feel better. It probably doesn’t. But hey… even in a worst-case scenario like Khadaji’s, it’s better to have no stomach than it is to not have your life!

My surgeon told my mom he had “outside help” when he saved my life. I was teasing him a little about it on the next visit. I said: Doc that is too much pressure! If God interrupted his busy schedule to come down and help you save my life, he’s going to expect me to be nice and stuff! I’m not sure I can handle that!

My surgeon stared off in the distance for a little and then said: You were on the table 10 1/2 hours. Every time I thought you were done, you just kept living.

:eek: *Every time? *That has the uncomfortable feel of more than once! Suddenly I didn’t think I was so clever after all.

I still both smile and am a little horrified when I recall that conversation.

If you don’t mind me asking, how easy a sell was the surgery to the insurance company?

Almost easier than begging them for a new Prilosec prescription every month. With that particular PPO and insurance company, once you got to see a specialist, it was like their word was law and you’d almost always get whatever the specialist said you needed. Getting the referral to see them approved in the first place could be a challenge, however.

With the coverage I have now, it would probably be even easier as I can self-refer to any in-network specialist, and so long as I can make the 20% co-pay, they don’t seem to fight much.

A lot easier that I expected to be honest, although things weren’t helped when our nanny sprained her ankle and was off work for the week I was supposed to be recuperating at home, leaving me as the main carer for my 2-year old son who doesn’t understand the concept of “no uppie, daddy owie” :wink:

Eating is going well, I can manage soft food as long as I eat slowly and chew well, but the thought of eating large chunks of meat is still repulsive. I’ve had a couple of choking episodes when I have been careless with my eating, but the biggest issue is the bloating due to gas while my bowels sort themselves out - never have I farted so voluminously :slight_smile:

I’m off work this week again, and the nanny is back at work, so I intend to rest a whole lot more.

Speaking of which…

Grim

From people who have had this done, I’d be interested in knowing if you think that my GERD is severe enough that I should consider the surgery.

I have a Hialtus Hernia, just got the gastroscope done in Feb this year and found that out. I am buying a bed I can jack up and I’ve stopped coffee and bread and beer and I eat small meals throughout the day. I am also trying to lose some weight. I’m 6"3 and weigh 84 KG, when I was younger and weighed 77 KG I never used to get symptoms.

Despite this I still get reflux burps fairly constantly throughout the day, even after taking MucaSTA 3 times a day. My concern is that this will do irreparable damage to my esophagus.

I already asked my specialist about surgery and she recommended instead I stay on medication for an entire year and see what happens. I’m confused about this, she did the gastroscope she knows I have a Hiatus Hernia, surely as soon as I stop taking Buscopan, MucaSTA and the other one I forget then the symptoms will come back even worse.

Any comments welcome. Also what is the recovery time of the latest keyhole Nissen Fundiplication surgery?

I have not had the surgery, though it’s certainly something that might be on the horizon at some point. I started a thread recently asking about “silent reflux” because that seemed (still does, really) a reasonable explanation for some symptoms I’ve been having.

The gastro suggested doing another upper endoscopy. I had one 3 years ago due to reflux symptoms that turned out to be due to a medication side effect, but at least we have a baseline. Upshot: symptoms are slightly worse: while I haven’t yet found the report from 3 years ago, the esophagitis hasn’t improved / may have worsened slightly, some gastritis as well. The good news: no hiatal hernia, no Barrett’s, and no bile reflux.

So for right now we’re trying a higher dose / different PPI and will see what things are like in a month then discuss what (if anything) to do next. It’s quite possible they’ll want to redo the upper endo when I have my next colonoscopy later this year. I sure hope they do the upper one first ;). In any case, I’ve been spending a lot of time at Google Medical College lately, which shapes my ramblings, and maybe is some food for thought.

I tried finding Mucasta but the closest thing I found was Mucosta (O not A) / rebamipide. Is that what you’re taking? There are other medications used to treat reflux and hiatal hernia - the proton pump inhibitors (PPIs) are the “gold standard” - those are things like Prilosec, Prevacid, Aciphex etc. Are you using one of those? What about the H2 blockers such as Zantac? Cytotec is another stomach protector (I wonder if it works similar to Mucosta?).

It’s also conceivable that a surgical repair “just” of the hiatal hernia might be done. I know the two surgeries are commonly done together, but after discussion with your doctor, maybe that would be an option.

In your boat - and I am sure there is a lot of detail we don’t have - I’d make sure I tried the more conservative treatments and gave them a fair shot before going with something as irreversible as fundoplication. This is because, well, fundo IS irreversible from what I’ve read, and of course it is painful and unpleasant. Doing a lot of googling will give lots of anecdotes about the first few weeks and the liquid/soft diet you have to follow, etc. On the other hand, long-term PPI use has significant concerns as well. Not deal-breakers necessarily, but increased risk of certain pneumonias, nutrient absorption worries, osteoporosis, and clostridium difficile - that stomach acid kills off pathogens, and suppressing it makes it harder to kill 'em off.

Having fundo might well let you stop the stomach meds, though not everyone finds permanent relief.

What is the Buscopan for? I’d never heard of it, but a quick search says it’s an antispasmodic (similar to something I once had when I had a nasty bout of wouldn’t-go-away-for weeks, sudden-agonizing-cramps diarrhea). Is that intended to treat your hiatal hernia/GERD, or something else? I’m just not familiar with its use in GERD. What would the surgery do for your need to use that?

What’s “the other one” (the drug you couldn’t remember)? I’m guessing it’s a PPI but could be wrong of course.

At a high level, my knee-jerk reaction in your case is that yes, it’s a good idea to give all the medicines and lifestyle changes a chance to help. While they may not “cure” the symptoms, and you may find they don’t even help that much, it’s worth giving it a try so you really know what it takes to help w/o surgery (or that the nonsurgical approach simply does not work). If you didn’t have Barrett’s 2 months ago, you probably won’t manage the deed in another 10 or so.

I’m assuming there haven’t been any huge advances in laparoscopic (I’ve never been a fan of the “keyhole” term.) Nissen fundos in the past thirteen years. Recovery was pretty quick, IIRC. I was on liquid diet for a week, then a week or two on soft foods. I know I was out of work for a week, but it may have been two weeks out.

And when I say liquids, I mean liquids that can be slowly sipped - things like Glucerna or Ensure. Then, on to cottage cheese, bananas, retried beans, mashed potatoes and such.

Thanks Mama Zappa. The third pill I take is Motilum , I just checked.

From what I’m reading here even if 100 percent successful the Surgery will not restore me to “normal” stomach function so yes I am better off trying to live with it.

I don’t quite understand why they can’t push the herniated park back down where it is supposed to be and then do some surgery to improve diaphragm function or even somehow use sutures to keep the stomach back under the diaphragm. Nissen fundiplication seems like a bizarre solution to me, but I guess theres a good reason I’m not a surgeon.

But they can!

As that link notes, it’s often combined with GERD surgery (i.e. fundoplication). I don’t know what the indications are for doing the combined surgery vs. “just” doing the hernia surgery - maybe the general consensus is that “while we’re in there, might as well”?

Reading the Mayo page, the stuff you’re on (Buscopan, Mucosta, Motilium) are not listed as standard treatment for GERD/hiatal hernia. From searching I did a couple years back, and again when you posted, they sound more appropriate for someone with stomach motility issues, vs. first-line GERD/hernia treatments.

3 years back, my doctor really really pushed me to try Reglan (metoclopromide) which is a dopamine antagonist and can help with motility issues; this was when my suddenly-worsening GERD symptoms were completely non-responsive to increased PPI use. I think that Reglan and Motilium are in the same class of medications, at the very least they seem to have similar effects. Reglan was a bad choice for me because it counteracts another medication I take for Restless Legs Syndrome, but I agreed to try it. I took one pill, and the effect was similar to, say, washing down a few antacids… with lemonade :). Reglan is listed as a treatment for GERD on the sidebar that displayed when I did a Google search; Motilium was not but that doesn’t mean it’s not appropriate sometimes.

Bear in mind, I’m not remotely a medical person, my learnin’ comes strictly from the interwebs, and I don’t know you or your medical history. But I would definitely urge you to make sure you understand why you’re bring prescribed that course of medications - e.g. do they suspect motility / emptying issues being part of the picture, would adding or substituting acid reducers be appropriate, etc.

Have you had any other tests such as a gastric emptying study?

I have no idea what effect fundoplication or hiatal hernia repair might have on motility issues, if you do have them. That’s worth asking about. It would seem that the hernia repair might be good in any case, though if you’ve got food refluxing up now, and refusing to go south as well (the motility problem), having a fundoplication might make you more uncomfortable by giving you no way to relieve the pressure. I could be wildly off on that, haven’t tried searching that scenario; I’m just thinking the sheer physics of the thing (take a baggie of mush, cut holes in both ends, pinch both holes almost shut, and wonder why it won’t get empty).

Answering my own question about fundo with gastric emptying issues:
From here

Maybe it’s a matter of “well, if you won’t let me go up, I guess I’ll just have to go down dammit” ;).

And another interesting article

thanks again MZ. I suspect my motility issues were temporary when I last checked in to hospital.

I’m going to give it six months and see if I can improve my situation with other means but in the meantime get a price on the surgery. Incidentally I live in Japan and I’d be flying to Thailand to get the fundoplication done at a private clinic.