Upcoming Nissen surgery

I had a nissan with a fundilplication with a 3 in myotomy at my LES it did not take any of the spasms away that was in oct. 16 so finally went to our mothership in danville pa and had a poem procedure done .while the dr. was doing the procedure about 5 min. Into it i had a spasm and he could not move the scope till it relaxed this was done in june 17 the procedure is making a myotomy inside my esophagus which was about 5 in. Now remember a average esophagus is about 9 in.so i have had an 8.5 in. Myotomy it helped a little but now having severe spasms all up an down my esophagus.i have not worked since jan.30 2017. And by the way I am an SURGICAL technologist in our operating room . I hope this helps in making a decision. Let me know if you want a list of my 9 meds I am on let know. Michael Hunnell here nice to meet you.

I am sorry i forgot to ask if you were diagnosed with achalasia? The spasms get bad and won't let food into the stomach there creating spasms

It will all depend on whether it is the reflux that causes the spasms.

​It is possible that spams continue / develop after surgery, as it is possible that it is the nerves that cause the spams.   I think you should probably ask your surgeon for his assessment of what is causing the spasms.

Please please get a second, even a third opinion. Even if you have to fly out of state to another to see another specialist. If your circumstances will allow for that. This is a very invasive procedure and you MUST have all your "I's" dotted and "T's" crossed. If I didn't do it regarding my Pancreatitis I would have ended up having a very dangerous and radical surgery that I did NOT need. That, and being a health care professional saved me from one of the biggest mistakes I could have easily made. Dr's's do not know everything. And unless you have two or three different opinions first, I would NOT have the surgery until you do. I'm not saying that you don't or want need it, I'm only saying that there may be other less invasive options you are not aware about and/or your Dr. doesn't know about or think you are a candidate for. One of the best pancreatic surgeons in the Southeast told me that I was NOT a candidate for something that I felt in my heart I was. And I proved him wrong. Follow your heart and your instincts always and educate yourself enough to understand and know that whatever decision you make, you are making the best one. Certain surgeries can cause life long adverse reactions and I don't want this to happen to you or anyone else. Do your homework and do it well. 

DJ-RN

  Hi Julie, I don't understand your doctor. Usually when you get pain in your chest like I use to get. Oh my god I would think i was having a heart attack. I had my lower sphincter cut out which they can do using POEM or a Heller Myotomy. A Nissen Fundoplication is a 360 degree wrap of your stomach wall around your esophagus. Did you already have poem? I had poem a year ago and had a partial wrap in April of this year and on September 14th I'm having a Toupet Fundoplication which is a 270 degree wrap of the stomach wall around the esophagus to block acid from coming up the esophagus. Please let me know what tests you have had. Something is not right 

The Linx device is a metal bracelet which is magnetic and is designed to hold the lower oesophageal sphincter closed, but with sufficient flexibility to open when required for swallowing.   It is a sensible approach to controlling reflux for some people who do not respond to PPI medication like Omeprazole.   It can also be used when a hiatus hernia is being repaired I believe.

?Occasionally you can have a blockage or problem higher up in the oesophagus that causes regurgitation and spasms, and the lower oesophageal sphincter is relatively OK.   The important thing is that the diagnosis is made after all the relevant tests.   It will depend on what is causing the regurgitation and where in the system this is occurring.   The analysis of where the problem lies, if it is an achalasia-type problem, is through high resolution manometry to illustrate the pressure exerted by the peristaltic muscles at different points along the length of the oesophagus;  and a time swallow test of substances with different consistencies like marshmallow etc.

?Sometimes spasms do occur after surgery.   We had a meeting of around 27 achalasia patients on Monday evening, and the great majority of them found that spams improved after myotomy surgery.  When the spasms continue afterwards it can sometimes be because of scar tissue after the operation.   I think reflux can be a cause of spasms, and if the reflux is controlled, this should logically improve, if indeed reflux is the actual cause.

Sometimes spasms can occur after anti-reflux surgery with gastric bands and, in some cases, the Linx device.  

?There are a number of different variations of the fundoplication wrap which can be 360 degrees or only a partial wrap.   There are illustrations of this in 'A Patient's Guide to Achalasia' that you can download from the website of the Oesophageal Patients Association (under the Oesophagus and Achalasia).

On the question of having a Nissan procedure to resolve spasms, I imagine that it would only take place if it were definite that it was the reflux that was the cause of the spasms.   

There is a long term health benefit in reducing exposure to reflux.

I am sorry if this is not a definitive answer to whether you should go ahead or not!