When to & not to consider NISSEN FUNDOPLICATION - Digestive Disorders Message Board

madara · 04-28-2004, 01:47 PM

This was drilled into me today by GI and I thought might help some here since I never seen these facts in my 2 years of internet research considering asking for FUNDOPLICATION and my GERD problems. This may very well explain why we have half people feeling great and rest feeling awful after Nissen.

"it benefits only those patients who have symptoms caused by the reflux of acid into the esophagus because of a hiatal hernia and/or a defective lower esophageal sphincter"
"Indeed, a fundoplication can severely worsen the symptoms produced by esophageal motility disorders or other GERD causing problems"

Peachy, my first endoscopy 2 years ago showed no HH and I dont remember him saying I had defective LES.
Going in for mobility emptying test next week, sounds like rest of GERD suffers out there are screwed if dont have HH or Les problem

From what I was told today if second endo, if he orders ones does not show this I have live with refluxing on everything and nonstop yellow vomiting and extreme chest pains around esophagus permantely.

sara52 · 04-28-2004, 04:48 PM

Hi Madara,

Almost everyone that has acid reflux disease has a bad or weakened LES...If not then it can be assured a fundoplication would not help. Fundoplication creates a new LES..It uses a part of your stomach (fundus) and wraps it around (plication)the distal esophagus forming a new LES....Most of us reflux because the LES is supposed to stay closed except when we have consumed food or liquids and then it opens to allow passage into the stomach..Reflux occurs because the LES is either wide open or partially open all the time allowing reflux back into the esophagus.Motility disorders are not good for anyone thinking of reflux surgery as fundoplication worsens esophageal motility making it hard to swallow.Noone should have this surgery without first having a manometry making sure you have enough motility to even allow surgery. EGD is not really a good test to diagnose reflux..EGD is gold standard to diagnose damage in the esophagus from reflux, ulcers, strictures, barrett's esophagus,stomach inflammation and duodenal inflammation. A 24 HR PH study is a better test to diagnose reflux, as it is possible to have reflux and to have not yet progessed to esophageal damage from it. You would be better off being diagnosed before damage occurs.

Sara

madara · 04-28-2004, 06:29 PM

Ah. Hey I had 24 Ph test done two months after endo two years ago. Boy did that test stink, keep choking on wire. Results were extreme gerd. I remember nurse saying bad bad gerd we asking if those numbers were high. Hmm so if everyones has LES issues wonder why my doc today made it sound like I did not apply, feeling toyed with again

Going in for gastric emptying test next tuesday I guess that for the best rule that out and then he wants be try this reglan until I seem him in month, possibly do second endo. I rather not even try reglan unless if offical I have slowed emptying, as I see just terrible things about it. So anyhow I survive that, and I get second endo I that figure will be like first and not show hernia or anything earth shattering. Then I back at square one. I wonder if you can just over ride GI and talk to surgen then. Theres no definite test to prove my LES is not working right? Cuz I thought that manometry test proved to him I was okay and had perfect working LES. I ate crackers , etc it looked fine to tech.To me its like duh if 80mg of nexium day for two year does nothing for you as you still vomit bile, have server chest and burning.

Katie G · 04-30-2004, 10:43 AM

Hi there - ditto for what sara52 says. The EGD only reveals damage to the esophagus, the 24 hr pH probe measures episodes and amount of reflux, and the manometry will reveal the motility of the esophagus and the function of the LES. If the motility of the esophagus is abnormal, a fundo should NOT be performed since the surgery could impair the motility even more. If the LES is weak, and motility is normal, fundo surgery is indicated to provide a "tighter" LES.

I was informed that my esophageal motility was fine, but the doc never said a word to me about the LES. After I had done extensive internet searches about fundo surgery, GERD, etc., I discovered I needed to ask him what the results of the LES were from the manometry. That's when he told me my LES was hypotonic, and no amount of medication was going to change that.

So the fundo surgery is basically to replace a low or non-functioning LES.

Katie G

madara · 04-30-2004, 11:31 AM

Thanks you two. Its manometry test I had right before PH test two years ago with wires that shows LES function! ah I see Those two tests were outsourced to another place and I have never seen them in my medical records, I have to spend few days with some red tape to get look at them and send copies over to my primary. Thanks much. I think I just about explode though if its shows those same things you mentioned and I be suffered additional two years. I have strong feeling it is, and same feeling I had about my MS when no one would take look at my spine and sure enough. It really stinks to fall thru medical cracks and trying not to be too paranoid I really wonder if my title 19/forward card for insurance has alot to do with it, minus fact your just number for doctors. Well I do this empty test tuesday to prove not mobility, rule that out, but I think I pass on reglan until I see GI in month. It just does not make sense to me use something for condition I may not have, especially when type in name in search engine and first 4 hits are join reglan lawsuits. sigh