GERD after POEM or Heller Myotomy with Fundoplicaiton

Posted , 4 users are following.

This discussion has been locked due to a period of inactivity. Start a new discussion

Hi all.

My name is Lisa and I'm trying to decide between POEM, which I'll have to pay for, and a Heller Myotomy with fundoplication although I need to ask which type of fundo my hospital practices. I'm interesteed in hearing your experiences with either surgery, especially regarding GERD afterwards. Basically, are you on GERD meds, do you have GERD symptoms and how badly? Based on my research, its seems that although most doctors assume POEM patients will have more GERD, but they often don't since the muscles aren't divided as much as in the Heller Mytotomy. My doc, who doesn't do POEM, thinks that POEM is setting yourself up with a lifetime of GERD.

It's my understanding that POEM patients go home on GERD meds and then are weaned off to see if they still need them. Is this true? Also, for those of you who had a Heller myotomy with fundo. What type of fundo did you have and what is your post-op GERD expeience? 

Thank you for any info you can offer in advance. 

Some info from http://www.asge.org/uploadedFiles/Publications_and_Products/POEM_PIVI.pdf:

"Dor fundoplication was found to be less effective that Toupet or Nissen fundoplication in controlling postoperative reflux, but Toupet and Nissen fundoplication was associated with higher rates of postoperative dysphagia." 

Lisa

0 likes, 4 replies

Report

4 Replies

  • Posted

    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.  

    Report
  • Posted

    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.

    Report
    • Posted

      Hope your good progress continues.   Sometimes it is just as well not to get involved in the surgeon's technical details.   I am told that 80-90% of patients get benefits from this surgery.
      Report
  • Posted

    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.

    Report

Join this discussion or start a new one?

New discussion

Report as inappropriate

Thanks for your help!

We want the forums to be a useful resource for our users but it is important to remember that the forums are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the forums is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.

newnav-down newnav-up