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Gastroenterology (Expert Forum)

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Repeat of Fundoplication....im scared ..any advice

Answered by

Kevin Pho, MD - Internal Medicine

Kevin, M.D. Boston - MA

This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.

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MedHelp Member's Question

Repeat of Fundoplication....im scared ..any advice

by lee1971, Sep 03, 2003 12:00AM

Tags: digestive, nissen, scared

Hi im Lee from London England. Almost 7 years after my Fundoplication (wrap) surgery ..by keyhole method, I have this year been experiencing a return of symptoms..quite bad in some periods. Mainly bloating, nausea, prolonged indegestion, occasional vomiting and of course acid reflux. Following extensive tests I have been told my wrap has now failed and repeat surgery is required. I am concerned about the success/risks of this..will I be worse off after?...I have currently just started taking Zoton (30mgs a day)to supress acid but this dosn't really help the indegestion/nausea bloating ( am trying some domperidone for this)...would appreciate some advice on repeat fundoplication or any other advice on my symptoms..thanks...worried from England

Doctor's Answer

by Kevin Pho, MD

, Sep 06, 2003 12:00AM

A redo Nissen fundoplication is necessary approximately 7 percent of the time in studies. Wrap failure occurs after both open and laparoscopic fundoplication, with varying patterns of failure. Transdiaphragmatic herniation is the most common reason for recurrent GERD after laparoscopic fundoplication, whereas wrap disruption is the likely mechanism of failure after open fundoplication.

If other viable options have been exhausted, then a redo fundoplication may be necessary. Cytoprotective and/or promotility agents may have a role. If gastric emptying delay is documented, treatment by endoscopic or surgical pyloroplasty may allow symptomatic benefit without redo gastroesophageal junction surgery.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,

Kevin, M.D.

Member Comments (4)

by tessa0825, Sep 03, 2003 12:00AM

Hi, I think the best thing you can do is make sure you get a good surgeon who is very experienced with this surgery and ask ALOT of questions before agreeing to anything.....It seems that most people spend more time and energy finding a good place and a top notch mechanic to do auto repairs that what they do picking out a surgeon for major surgery....Make sure you find out what "his/her" sucess rate is with this type surgery, not just what the overall sucess rate is.....Also, if you have a surgeon that isnt receptive to your questions then you have the wrong surgeon....The good ones will encourage you to ask questions, and always ask them before your visit ends if there is anything else you need to be aware of?...Good luck, Tessa

by PBear01, Sep 05, 2003 12:00AM

To: Lee

Hi Lee,

Have they discussed with you the implant option that is available now? I'm not sure if it is available in London but it is an implant that is done during an endoscopy that is supposed to help with reflux. I know I would sure rather exhaust all options before having nissen surgery again. My nissen surgery has left my life in quite a mess. Greta that posts on this list had the implant done, you might want to ask her about it. It's called the Enteryx implant. I am only just over a year out from my surgery, and my wrap has not failed, as of yet, I surely don't have any symptoms of reflux, but I know if I ever do, I don't ever want this surgery again. Right now they are discussing digestive pacemaker surgery for me. Sounds fun huh? lol As for the domperidone, its not even available in the states where I live, it was pulled from the markets here, considered too risky for use. My doctor told me today that I would need a cardiac doctors clearance before I can take it. I have heart palpitations so I don't know if they are going to allow me to or not. Best of luck to you. Let me know how it all goes.

Pam in Ohio

***@****

http://groups.yahoo.com/group/RefluxSurgerySupport/

(the link to my support group on yahoo)

by Misfit, Sep 07, 2003 12:00AM

I already had 3 Nissen Fundoplications and everyone of them failed. I am now experiencing terrible heartburn again. I did not have any problems with my re do surgeries, other than they just didn't work very long. The last one lasted 2 years, which is the one that lasted the longest.

I would try a re do, but make sure they think you can get it Laparascopically again.

Any advice for me? I need help and I don't know what can be done.

I am looking into new treatments, but I was already told that the Enco Cinch would not help.

Any advice?

by lee1971, Sep 11, 2003 12:00AM

Thanks for the advice people...I think my main worry is the sympoms im getting and if repeat fundoplication will help? Being treated with a powerful antacid like lansoprazole really stops my acidity but what it dosn't stop are what i consider to be my main symptoms( that can come and go, few weeks on few weeks off etc) which are prolomged feelings of bloating and discomfort after food ( classic indegestion I suppose),also belching somtimes nausea..Im presuming that these are also normal sympotroms requiering repeat fundoplication.?

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