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Gastroenterology  (Expert Forum)
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Stomach Pain post Nissen Fundaplication
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

Stomach Pain post Nissen Fundaplication

by Ci CI, May 04, 2004 12:00AM
I developed gerd about 15 years ago. I had to have the sticture in my esophogus (SP?) dialated about 6X at the rate of 2 times a year.  I also had a cough and was aspiraing acid from the reflux. I started with Tagament and am now on Acidphex. I've been on everything in between.  In Sept. of 2001 I had a laproscopic Nissen Fundaplication in Chicago.  2 months after that I had an emergency bowel resection for diverticulitis. I have not recovered since.  I lost 40 pounds, but have gained it back in the last year.  I had 3 episodes of severe pain and free air.  The doctors were going to operate but the leak closed and while they tought it was in the fundaplication they were not sure. My last episode with free air was in August of 2002.  Since then I have almost constant pain below the sternum and stomach area.  I have gone to the emergency room 3 times with severe pain, the last time a month ago. The xrays show no free air and no obstructions, but a severly distended stomach full of air - no food. They say it was the size of a loaf of bread. I have that same pain often and my stomach is distended like it was when the x rays showed it to so large. I know that Nissen Fundaplications are fairly new.  Is this pain common?  The surgeon that preformed mine is out of the picture. I have had every test possible and my Gastroenterologist is sympathetic but stymied. He thinks it may be something like Stomach Vulvitis? He has sugested Mayo's as they should be up on the after effects of this surgery.  What is your opinion?



Thanks, CiCI
Doctor's Answer

by Kevin Pho, MD, May 05, 2004 12:00AM
I would have this evaluated by a second surgical option to ensure this isn't a complication from the surgery.  Typically, pain should not be present 2 1/2 years after the procedure.  If not, I would assume that a repeat endoscopy has already been performed as part of the GI workup.  



If negative, other tests to consider would be a 24-hr pH study to ensure GERD isn't recurring post-surgery, as well as a gastric emptying scan to evaluate for gastroparesis.  Gastroparesis is possible in the setting of stomach distention.  



I would obtain another GI and/or surgical opinion and discuss the possibility of the aforementioned tests.



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.



Kevin, M.D.

Medical Weblog:

kevinmd_b
Member Comments (12)

by nursedeb, May 05, 2004 12:00AM
Hi,

I noticed you had a Nissen fundoplication. Was that to repair a hiatal hernia? I have a hiatal hernia and my symptoms are pain and especially spasms belows my sternum after eating. I was wondering if you had similar symptoms before your surgery.

Thanks,

Debbie

by tessa0825, May 06, 2004 12:00AM
To: nursedeb
Nissen fundoplication creates a new LES ( reflux surgery) by using a portion of your stomach and wrapping it around your distal esophagus. They also do hernia repair as part of this surgery.

by Ci CI, May 06, 2004 12:00AM
To: nursedeb
Hi, No, I didn't have this pain before the Nissen. My pain sounds like yours.  Under the sternum, after eating, but sometimes on an empty stomach too. It's like spasms and a burning feeling, and I get very distended.  I have trouble breathing from the pressure.



My surgeon claims these symptoms are not from "his" surgery so no help there.  I'm planning to go to Mayo's and I'll let you know what they say.



From your name I assume that you are a nurse.  I am too, although inactive.  



Sylvia  



by Ci CI, May 06, 2004 12:00AM
To: nursedeb
Hi again, I just reread your comment and realized that you have not had a Nissen.  My symptoms before the Nissen were severe heart burn, difficulty in swallowing from a stricture caused by the acid, back pain radiating from the area of the sternum, and a chronic cough.  The Nissen cured the heart burn and all of the above except the cough that has returned.



Now I am back on a acid blocker and have new pain.  Bloating, gas, and the severe pain in the sub sternal area.  At first I was unable to eat except for small bites.  The Nissen makes your stomach smaller.  After 2 years I got my appetite back, but still feel better if I have very small meals.  



I can't say that I would reccomend the surgery. Although it cured those symptoms, I now have a whole set of new ones.



Your symtoms sound maybe like gall bladder to me.



Sylvia (Ci CI)



by renee1952, May 06, 2004 12:00AM
To: Ci Cl
Welcome to the world of post fundoplication...We seem to go into this surgery very naive in the fact we believe we might feel better afterwards..I'm almost a year after surgery and I have more stomach pains now than I did before surgery..The gas bloat is bad also..Im also back on PPIs already as Im still refluxing, swallowing is still a problem sometimes..Im not sure what it accomplished. I don't understand why Drs. don't more fully explain post-surgery consequences to us prior to having this done. To many folks have the same complaints afterwards for the Drs. to be totally unaware it is happening.

by surgeon, May 06, 2004 12:00AM
It indeed sounds as if you are having "gas b