What Pre-op Questions to Ask Surgeon?

You are right Robert. They will lie to you sometimes. I'm sure they watched or assisted in many during their residency. I want to know how many they've personally done themselves in self practice.

Thank you, Robert. I'll ask about pre- and post-surgery diet. 

For me the only reason I had my surgery was because I was at the age where my friends were dropping dead all around me and I was having severe chest pains every night and couldn't be sure if it was my heart or esophagus. If I had to do it all over again I'm not sure if I would choose surgery. It opened up a different can of worms. I would try everything and anything before surgery. I hope whatever you do choose works best for you, good luck

I guess it's really tough to decide what to do for anyone once diagnosed. I appreciate your honest answer.

Personally, I think it's best to manage with the least invasive procedures like dilation of the esopagus for as long as you can. My doctors told me they don't do the balloon procedure any more. That one helped the most but I can see how it could be risky because it involves ripping the LES. Scar tissue could grow around it and you're back to square one. For me, this laparoscopic surgery is a last resort because my eating is so difficult now. I'm hoping it improves things. Over the years, I've learned what foods are difficult to eat--rice and bread were the first foods I had to eliminate. My acid reflux was also a problem but that seems to have improved on its own most recently. I'm not taking anything for it. I did have to eliminate raw tomatoes, oranges, and grapefuit as I think they were causing the acid reflux. This forum is a great place to ask questions and share thoughts.

Thanks Maya for getting back to me. Sounds like balloon dialations helped you to deal with it for this long. Any other life style management or so that had helped you during this journey? And your list of pre-op questions will be really helpful for us too, so thank you and have a very best of luck with your choice of the precedure to go with.

I too would go with the less invasive procedures first as well. I don't know why your Dr. stopped doing dilatations but they are still done everyday. You just need to find an institution that does them if that's what you want. A POEM may be a better choice for you than a Myotomy. With a Myotomy it's almost guaranteed that you will develop severe GERD afterwards. I would do your homework and do it well before you undergo any invasive surgery.

How they prevent GERD from happening with POEM?

Hun, I don't know for certain. I believe they use part of the sphincter (LES) to make a makeshift valve or flap. But this doesn't guarantee that it will prevent it. The posts that I've read of people who have had POEMS have acid reflux afterwards and are on a few medications to treat it. I wish I could help you more. But I don't want to tell you something that's incorrect. Google POEMS and esophageal Reflux Disease.

DJRN

Sure, I asked because since I read on your one previous post, as if you were saying that POEM might be a better choice than HM as far as GERD is considered, so I thought I might have missed something about POEM while I 've been reading about it, my bad. :-) Have a good Sunday.

I know all of this is so overwhelming. Everyone reacts so differently. Even by having the same procedure. We all just have to support each other and be there for one another. I wish everyone the best.

DJRN

With great respect I think it should be clarified that a myotomy will probbaly result in reflux, and it is the fundoplication 'wrap' part of the operation that recreates a form of valve that aims to prevent reflux rising (to counteract the effect of the myotomy).   POEM involves cutting the muscles inside the lining of the oesophagus and does not in itself involve a wrap, so the risk of reflux is high, unless something else is done.   With some patients this means taking anti-reflux medication indefinitely.  

?It is feasible that the POEM might be very carefully adjusted to avoid much of the reflux but I do not know whether this is realistically possible, so I would advise very great care.  

?If the issue is a choice between POEM and a conventional Heller's myotomy with fundoplication you have to be clear about what actual advantages the POEM does actually offer.   This is something best answered by surgeons and by medical authorities.

All I was trying to say is that it's more likely than not one will experience some type of reflux with ANY of these procedures. Wether it be a Myotomy, a Myotomy with a Fundoplication or a POEM and any types of wraps. This is one disadvantage to ALL of them because none of these procedures have been perfected.

Hi Alan, you are perfectly correct about both. POEM , they are not able to create a wrap and must be done later

I wanted to ask you if you have ever heard of the new procedure I just had done. For lack of a name , which it doesn't have yet , I was told it was a plication via a overstitch. During an Endoscopy with a brand new instrument that is able to lift the stomach wall and actually stitch it to your esophagus. I was told that my Dr is the only doctor in the country able to do this and I was the second person , unannounced to me to have this done. I know my doctor was the doctor who brought the POEM procedure to the US from Japan. I was curious, wouldn't not telling me that I was only the second person before doing the procedure on me break any kind of code or laws? Thanks Alan . As always your right on the money.

I have not heard of this, No, but I will ask someone I know who is a surgeon in the field.

I did ask my surgeon contact (UK-based) about the 'plication via overstitch.  He said:

'It's not new at all. It's an endoscopic plication doesn't work'  

I am sorry that the response was so brief - by email so there was no further conversation. 

I think this suggests that you should be careful and perhaps ask for further details about how this procedure is regarded by other surgeons and seek a second opinion?

Plication via overstitch has been around a while, but it is something that is just now being done in a different way. Not unlike the various types of Fundoplications they have. Perhaps Robert's surgeon did it in a way which has only been done a couple of times. I honestly don't believe that anyone has perfected ANY surgical treatments for Alchalasia. The various types of Fundoplications usually leaves one with a boatload of side effects as well as new anomalies developing afterwards. I haven't ever heard of one who had a Fundoplication, Heller Myotomy, POEM etc. etc. who didn't develope side effects from having one of these procedures. I think that there is much that researchers don't know and surgeons who don't no how to do it as of yet. I would personally suggest to anyone to not undergoe any one of these surgeries for as long as they possibly can. Sometimes the risks outweighs the benefits of it. I know I am not having any of them till I get in a position where my life is greatly altered and unmanageable. With my aspirating, I'd rather sleep sitting up than to have a Dor Fundo with a Myotomy. But, I realize that many people are experiencing much tougher symptoms that are debilitating than I am. So, I really don't know what I would do because I'm not walking in their shoes. I'm just saying less invasive procedures first and for as long as you remain a candidate for them is better than undergoing any of these surgical procedures.

DJRN

DJ, I believe the new issue with this procedure is that it's done through an Endoscopy and the instrument in new. That's all I was told

That would be a little too late Alan. It's already been done and believe your friend. I have had nothing but problems. I think my doctor got together with some guy in Israel and he invented this contraption that attaches to the endoscope and they are going to ruin a lot of people's lives. I've already contacted a lawyer and if what your friend said can be proved it's going to be my freakin mission to stop him and any other doctor from using it. They screwed with the wrong guy.

Robert, I would also do what you're doing. What is going on in many cases is Dr's's are using devices, much like they used a retrieval device for blood clot filters. These devices they're using are often not approved by the FDA and people's life's are being ruined. I'm sure if you ask your Dr. the name of that device he used he would probably tell you thinking that you were just curious. Once you have it, you can contact the FDA and register a complaint. But if you're seeing a lawyer he'll know how to go about it. I'm sorry you are having such a difficult time. PM me if ever you want to chat.

DJRN

Oh, ok. I wish you the best of luck.

DJRN

Robert, do you know what I touch to send a prvt msg?

Alan, you are right. Knowing which procedure is best for you is key. The only problem with that is surgeons are too eager to do surgery on you their way. They may excel in one particular type of Fundoplication or a POEM, but that doesn't mean the one they are good at is best for you. That's why I tell everyone to get a second, even a third opinion from both GI specialists and surgeons. I have found that a GI doctor who specializes in Alchalasia has nothing to lose or nothing to gain by telling you exactly what type of procedure you need. Then be referred to a surgeon who does that type best. Not the other way around. I've seen 3 surgeons and each wanted to do a different Fundoplication on me. Why? Because that's what they are known for, push and believe in. I Also saw 3 GI specialists and all 3 agreed on the same type of surgery I needed. Which was a Dor (partial) Fundo with a Heller Myotomy. Everyone reading this who is looking at surgery, I beg of you to get more than one opinion. Preferably from a GI specialists of Alchalasia.

DJ-RN

No I don't

This is somehow older reasearch paper but it might be helpful for knowing that the relationship between achalasia subtypes and treatment outcome: Outcomes of Treatment for Achalasia Depend on Manometric Subtype (although it can't be very conclusive given the sample size)

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Ty Alan. I don't know what was wrong with me. I was looking straight at that envelope. Lol. Ty again as always.