New operation for achalasia
Posted , 2 users are following.
ABOUT ME:
My name is Tim and I am a 45 year old male living in the UK. I have had Achalasia for 20+ years, having had numerous dilations, a laproscopic myotomy and an open one two years ago.
Achalasia has left me with a massively dilated esophagus, which narrows to a classic “birds beak” at the LES area. This causes food to back up at this point, often remaining static for days. This in turn has led to candida infection, and ulcers [stage III perforation] due to the fermentation of the static food. Because of this, I have chronic anemia [I have had to have a blood transfusion] when the ulcers hit a blood vessel. I have also been throwing up a mixture of acid, rotting food and some blood – not very nice!
Mr **** (my surgeon ) and I talked about having an esophagectomy – indeed a date was set for this proceedure. But on the day there were no beds and Mr **** suggested an new proceedure he thought might work. He called it a Cardioplasty, but when he described it to me it sounded like a Transgastric Stapled Esophagofundostomy or TSE.
THE PROPOSED OPERATION:
In the operation, he proposed to pull up the stomach on the left hand side to by-pass the damaged narrowed LES. This would then be stapled to the esophagus.
This should allow for a larger entrance into the stomach being created, allowing food to enter faster, eventually because food is no longer in stasis it was hoped that the ulcers would clear up and there would be a reduction in the diameter of my esophagus.
In theory the operation should be able to be carried out laproscopically, however, because of my previous surgeries – mine had to be open. The operation had only been done twice before in the UK, and this was to be Mr **** first.
THE OPERATION:
I had the operation on Thursday Sept 20th. I went into the theatre at about 12am and was on the general ward at about 7pm. Mr ***** said that the operation was very difficult because of the severity of adhesions that I had. It took him 1.5 hours just to seperate my stomach from my Liver. At one point, he thought things were so bad that he considered abandoning the attempt and converting the op to an esophagectomy. However at the end, he said he was very satisfied with the results, saying that the entrance into my stomach was wider than he had ever seen it before.
AFTER THE OPERATION:
When I came round from the aneasthetic I had the following things:
Nasal Gastric tube linked to a drain bag, in my nose
Oxygen in my nose
Cannula in left arm
Epidural in spine
“Roof top incision” in stomach with 29 staples
On left side just below that a pipe leading to a drain bag
A catheter.
On Friday morning I had a barium swallow to check for leaks. To be honest I am not sure that the radiologist knew what they were looking at!! However they did detect what they though might be a small leak, so I was kept on nil by mouth over the weekend. Mr **** thought it was not a leak, but part of the operation. The NG tube was removed on Monday as was the epidural.
On Wednesday I had another Barium which showed the same “leak” image as before. It was concluded that it was not a leak and that I could go home. The drain tube was removed and I had some yoghurt which I tolerated well. The hour long journey home was bumpy and uncomfortable but at last I was home.
At home I have been on a liquid/soft diet. Pain has been ok, but is worse that my last operation [probably because this was the third in the same area]. I am tired all the time and having to take things very steady. Once the swelling on my esophagus has gone down and I am eating real food, I will have an idea of the success of the procedure. I shall see Mr ***** at the end of October. If you have any questions please ask them and I will do my best to answer them
Thanks for reading!
Tim
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0 likes, 3 replies
Guest
Posted
I'm new to this site and have just read your posting in October - I do hope that you are going on OK. I have had achalasia for life - not that I knew that is what it was called until quite recently. I was told that all the nerve endings were wrong to my oesophagus and sphincter muscle to the stomach (this was in the 1960s) causing the muscle to be shut when it should be open and vice versa therefore the oesophagus acting as a pouch and drip feeding the stomach hence stunted growth (I posted a brief description just the other day on this site - maybe it might help someone), I was also told that my condition was quite rare in someone so young, I was 15/16 at the time. I had a Hellers operation in the late 60s and the muscles either side of my oesophagus cut 1980 to stop any restrictions there.This op was done after a balloon was passed into my stomach via a tube down my nose (I was fully awake) blown up to normal size and then attempted to be pulled back through the sphincter muscle - it had to be deflated to more than half normal size to get back through - not a pleasant experience! Before this I was given a multitude of different drugs to stop the muscles going into spasm, some of which spaced me out, amylnitrate being just one! I had these ops in Oxford then I dropped out of the radar - I should have been seen regularly after that but was not seen again until I started quite severe problems after moving to Kent mid/late 90s. All my notes from Oxford had been \"lost\" even my GP was not aware of my medical history - scary! I had to send to the Oxford hospital archives to get my notes sent to me! I saw a \"specialist\" in Kent who did not believe me until I had a barium swallow, which I had to insist upon - the radiologist was astounded at what he saw!! Basically food/liquid plops straight to the stomach without any \"oscillation\"/pushing from the oesophagus so I have to be upright to be able to swallow at all - sometimes it bounces straight back out!! I was then put on losec 20mg as I had very severe oesophagitis (burning of the oesophagus from the stomach acids - I have nothing to hold them back). I'm now firmly on the radar and coping well - I take 30mg of lansaprosol daily which is keeping the oesophagitis under control.
I am very sorry to hear that you had to endure such surgery when maybe having the muscles either side of the oesophagus cut and hence preventing the oesophagus from over narrowing might have solved the problem before it got too bad as I have had done.
I now suffer chronic anaemia and have had two transfusions when my haemaglobin went down to 7 (normal being 14-15) twice over a two year period and recently I have had intravenous iron over a 12 week period. I can't take iron orally as it is inclined to pass straight through! In fact I'm due to have a colonoscopy tomorrow (if I can get there through the snow) to try to fatham out why I get so anaemic. I have regular endoscopies to check for ulceration etc and have biopsies taken. I have polyps in the stomach which are kept an eye on. Through all this I do manage to lead a pretty active life although my diet is relatively restricted.
I hope that things level out for you and that you are able to return to a relatively normal life. I have learnt through all this that there is always light at the end of the tunnel however dim it might seem at times.
Best regards
Sally
Guest
Posted
Unfortunately, things have not improved - have needed another blood transfusion and surgeon is very unhappy with the quality of my life, despite the operation being technically a success. Am regurgitating black blood and food and food is still getting stuck.
I am scheduled to have an esophagectomy on Feb 18th.
Regards
Tim
Guest
Posted
I am so sorry that things have not improved for you and hope that your next procedure scheduled for February is more successful.
I do remember after my second op to cut the muscles either side of the gullet I regurgitated black blood and food for a while but things did settle down. I was put on the \"Black Box\" (Radionics) for a time afterwards which helped me enormously. At the time I was convinced the procedure had not worked because of the pain etc that I experienced after the op but as I said it took a while for everything to settle down again.
Wishing you all the best in February.
Regards
Sally