GERD after POEM or Heller Myotomy with Fundoplicaiton

To the extent that achalsia means that the lower oesophageal sphincter tends to be tightly clamped and does not allow food to pass through easily, relieving the obstruction by cutting muscles makes iot easier for food to go down, but almost inevitably means that the other function of the LOS valve, stopping reflux coming up, will not be so effective.   The fundoplication wraps, that accompany the myotomy, wrap the top part of the stomach around the base of the oesophagus tio recreate a valve effect to address this issue.   Nissan involves a 360 degree wrap, Toupet 270 degrees, Dor 180-220, amnd Watson 120 degrees.   Judging the right balance is a surgical decision.   So, it is not surprising that Nissan and Toupet may have a more restrictive effect because they operate further round the circumference.   There is also an issue about an ability to belch afterwards.   Exposure to long term stomach reflux in the oesophagus can damage the lining and create problems, so it is a matter of getting things as right as they can in the operating theatre, and then making the fine adjustments to combat reflux with medication afterwards.

I think you need to be careful about comparing different experiences, because each patient is different, and the problems might be occurring higher up in the oesophagus for some, which would mean that the myotomy would be longer / different.   I am not sure how POEM copes with combatting reflux afterwards.   There is not a 'wrap' as such.

The surgery generally does make a significant difference for 80%+ of patients. But you need always afterwards to continue to be careful about stress and tension levels.   The surgery may, or may not cure spasms.   The longer you leave it, the more likely it is that your oesophagus may become 'baggy' and less receptive to surgery in the future.  

I had no choice. I had Heller myotomy done May 2nd 2016

with fundo. So far so good. Where I am in Canada it was that or

botox. I keep Zantac with me just in case and have had one mild

attack of acid reflux on a nearly empty stomach. Which fundo I

had was not discussed with me.

I had the POEM on April 15th so about a month ago without fundoplication . There seem to be two schools of thought if you go to the Cleveland Clinic or my Doctor at Allegheny they do it without fundoplication and then put you on GERD meds which you are weaned off of. About 70% of the time that works unless you are like me, my tests showed Type 2 however when they got in they discovered i was advanced stage Type 1 and had to go the full 10 CM so i have had some problems with Acid reflux and they may go back in and do a fundoplication. If you go to the Mayo they do the POEM with I had the POEM on April 15th so about a month ago. There seem to be two schools of thought if you go to the Cleveland Clinic or my Doctor at Allegheny they do it without fundoplication and then put you on GERD meds which you are weaned off of. About 70% of the time that works unless you are like me, my tests showed Type 2 however when they got in they discovered i was advanced stage Type 1 and had to go the full 10 CM so i have had some problems with Acid reflux and they may go back in and do a fundoplication.  At present I take an acid reducer twice a day and that seem to be helping. I had to go off the other medication because two weeks after my surgery I developed what is known as a non-serum allergic reaction that resulted in my getting hives head to foot and having to go to the Emergency room to get Epi and bags of liquid Benadryl infused, I was in hospital for day and off work for seven ( they think it was delayed reaction to the antibiotics they gave me for surgery) but since we were not sure I had to stop all medication.

 If you go to the Mayo Clinic they perform \the POEM with I had the POEM on April 15th so about a month ago. There seem to be two schools of thought if you go to the Cleveland Clinic or my Doctor at Allegheny they do it without fundoplication and then put you on GERD meds which you are weaned off of. About 70% of the time that works unless you are like me, my tests showed Type 2 however when they got in they discovered i was advanced stage Type 1 and had to go the full 10 CM so i have had some problems with Acid reflux and they may go back in and do a fundoplication. If you go to the Mayo Clinic they perform POEM with fundoplication. I think every case if different and you have to do what is right for you. I did a lot of research before going with POEM and i don’t regret my choice. It is less invasive that the Heller, I think you are less prone to infection and it leaves other treatment options open to us. After all it is not a cure it is a treatment and different people will have different outcomes. Finally for what it is worth when they had me on the table with the endoscope, that was when they realized just how serious a case I was my esophagus was a crumpled mess and they are still trying to figure out why my symptoms overall were not much worse for much longer. The only conclusion they could come to was that I had slowly over the years changed my diet and manner of eating so that until the regurgitation and difficulty  swallowing became severe I just had coped without being fully aware of what was happening to me.

I wish you the best of luck and outcomes.