Nissen fundoplication

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Hello all, I have a few questions about the nissen fundoplication. I have read a lot about it and it seems like everything I read contradicts each other. Some medical journals etc say it has a good outcome but others say a poor outcome. I have rarely come across anyone online that has had the nissen for a long time most of the time they seem to fail. Or is this that the long term successes never go online?

Why do they slip or fail and how can one maintain their wrap for many many years? Does it have to do with diet and how you look after yourself after the wrap or is it the work of the surgeon? I certainly don't want to be on medication for long I'm really young and ppis are dangerous plus my LES doesn't work (did a manonety for this) I am more worried that it won't last rather than for the side effects.

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  • Posted

    Your observation that you only hear the bad stories is probably right.

    From the www DownWithAcid org uk book:

    A study published in Surgical Endoscopy in 2014 reviewed the durability of Laparoscopic Fundoplication over 20 years and concluded, "Long-term results from the early experience with LF are excellent with 94 % of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up. However, 18 % required surgical revision surgery to maintain their results. There is a relatively high rate of daily dysphagia but 90 % of patients are happy to have had LF." 

    From a report published in the World Journal of Gastrointestinal Surgery in November 2016:

    In the 90’s, Lafullarde reported an overall reoperation rate of 10% after LF. More recently, reoperation incidence is reported to be resembling 5%. A systematic review performed on elective LF documented an overall reoperation incidence approximating 0.6%. In the nationwide study from Denmark, an incidence near to 5% of redo antireflux surgery was reported in 2589 patients." 

    I had my Laparoscopic Nissen Fundoplication 9 years ago. It was the best thing I ever did and gave me my life back. This was after a lifetime (nearly 60 years) of living with reflux.

    Unfortunately my wrap did come loose following 5 hours violent retching from norovirus. My reflux symptoms flooded back. I had Collis Nissen revision surgery. (The Collis part rescetions the stomach to effect a longer oesophagus to promote a stronger Nissen wrap.

    And you're right not to be worried about side effects. Scare stories abound but most don't have a problem.

     

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    • Posted

      Do you know anyone else who's had the wrap for many years and is happy with it? Also have you spoken to many surgeons or people specialising in this type of surgery about the nissen do they agree that it has a long term success rate? A gastro I saw said 70% of people return to taking medication after do you think those people are most likely overweight or don't take care of the wrap after?

      Do you know any good surgeons in the Uk preferably in London? I was referred to krishna moorthy I don't know if you've heard of him.

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    • Posted

      I do know others who have had the wrap and are happy with it. Most don't actually go around talking about it but I have collected some patient stories which I shall be formatting to a leaflet our hospital can hand out (when I get time to get a round tuit smile )

      Sorry, I don't know Krishna Moorthy. I do know the gastroenterologist Dr Jonathan Hoare at Imperial. I'm sure they have a great team there.

      I had my surgery done at Southampton where we have an excellent team I would recommend.

      I don't know where your doctor dreamt up the 70% requiring PPI figure from. The research shows, ""Long-term results from the early experience with LF are excellent with 94% of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up."

      A paper published yesterday by a clinic in Baltimore reviewing their fundoplication recipients (43 patients) suggested "Reflux can recur in between 3% and 30% of patients on whom antireflux surgery has been performed, and so revision surgery can be required due to recurrent symptoms or dysphagia in approximately 3% to 6% of the patients."

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    • Posted

      thanks for al the great info Barretts. I have one more question but dont know whether youd be able to help me. I am hypermobile and i think this is why i have reflux do you think this would make surgery less successful for me? many thanks again!
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    • Posted

      I can see no reason why not. But, obviously, it's something to discuss with the surgeon if you reach that point.

      Are all your joints affected? (With me, it's just my thumbs.)

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    • Posted

      most of them yes. Im worried that they will refuse surgery for me  becuase it may not work as a result of the hypermobility and ill have to live in pain and risk cancer. Im only 22 i cant imagine being in this pain for the rest of my life i am so depressed.
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    • Posted

      If you're a suitabe candidate for fundoplication, I don't think joint hypermobility would be a problem. The operation is laparoscopic within the abdomen and shouldn't affect joints - apart from puffing up your insides with air which some people find causes a small amount of discomfort to their shoulder blades for a short while afterward - but no dislocation.

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    • Posted

      I think with hypermobility problems there is a chance with the wrap not staying in place because it causes problems wit tissue etc I've read using mesh is best to hold it place. Is this what most surgeons use in the uk if not which surgeons do you recommended that use this type of method?

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  • Posted

    Hi i have yhe same delema , I know some one who had one 8 yeras ago and has never looked back and also some one who had one 20 years ago and has been fine  so its hard . I realy believe the outcome depends highly on having it done by a surgeon who has done many and has a good success rate.

    The internet is amazing and these forums a god send but there is the element as you say you only go looking for thimgs when there is a problem.

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