Been offered Fundoplication, but are my symptoms bad enough?

Digestive health
1

I am a 36 year old male, who was diagnosed with a 2-3cm Hiatus Hernia at the end of 2015 after a gastroscopy. The lead up to this was a year of acid reflux symptoms, and me taking 20mg of omeprazole which worked initially, but then stopped working.

I was told to immediately start taking 40mg of esomeprazole, which worked well for around 6-12 months, but then I kept having acid reflux symptoms - although I admit I was not adjusting my diet at all at this point. Along with my 40mg of esomeprazole in the morning I started taking 150-300mg of ranitidine at night, I reduced all the main acid producing foods from my diet (alcohol, caffeinated drinks, fizzy drinks, most kinds of fruit, onions, tomatoes etc), and stopped eating after 6pm. I also took gaviscon when my symptoms were not controlled by the pills.

I have good and bad periods, but during a bad period of high acid reflux I went to my doctor, and he agreed to arrange another gastroscopy. This was the middle of 2017, and the results were - my hiatus hernia had grown to 5cm, I had polyps in my stomach (a common side effect of PPIs I now realise), and a schatzki ring (narrowing) in my lower oesophagus. I then had a 24h Ph study and manometry test, which showed I did have acid reflux although not excessively so, and I had a slightly weak swallow. I was told I could now speak to a surgeon about fundoplication if I wanted to, and I have had my first meeting him where he explained the surgery and has now given me a couple of months to think things over and decide what to do. He said because of me slightly weak swallow he would only do a partial wrap as otherwise there might be a risk that I would struggle to swallow anything. This makes me worried that the procedure will be less effective at stopping the reflux?

I have read many many things about the fundoplication surgery, most of which scare the hell out of me. It is clearly major surgery which causes life-changing side effects, and is also not guaranteed to actually solve the problem! However, looking at the stats it does seem than long term most people are happy with the results, despite the adjustments you have to make to eating and the many other side effects. It just seems very much like a decision not to take lightly.

I have good days and weeks where I don't get much acidity and pain, should I even be considering this surgery? Is it really only for people who are in awful pain and discomfort all the time? If there is some chance of mostly controlling my symptoms with medication, should surgery be the last thing I should be considering?

However the other worry is the potential long term side effects of PPI medication. I've read about the potential of brittle bones, and the reduced absorption of certain vitamins and minerals. I was also very worried by the recent release (end of 2017) of a study done in Hong Kong, which potentially saw a link between long term PPI use and Stomach Cancer - although there are a lot of qualifications to their results, it is still worrying.

Should I take the risk of surgery and all the likely long term side effects, and potentially make my life much worse than it is right now, just get off the PPI medication? Or should I stick to the medication if it is mostly working for me? I’m still mid 30s, so the thought of being on medication for another 30-40 years doesn't sound great. I'm just really worried that if I have the operation I'll end up in a worse position that I am now....although potentially it might save me from any PPI side effects in the distant future...but nothing is every guaranteed is it...

I would love to hear from people who have had the fundoplication operation, and know what their life is like now. Although I am aware that you are more likely to be posting on internet forums when you have a problem!

Thanks for reading.

2

Also I forgot to add, is it better to have the surgery when you are younger rather than older? And since my hiatus hernia has grown over 2 years, is it likely to increase in size? Is it better to get the surgery done before it gets bigger? Is the surgery harder/less effective if your HH is bigger?

Thanks again.

3

Did you ask the surgeon about fixing the hernia?  maybe that would solve the problem. I think that may work better then your other options.

4

Hi Jack,

Like yourself I thought my symptoms weren't as severe as some people on here, but I went ahead and had the surgery on 5th February - and can honestly say it's the best thing I've ever done.

I had the 360 wrap and hernia repair and am just about back to normal already.

I was in hospital for one night as quite late down to surgery.  I had that week off work, worked from home the following week and then went back into the office after that.

I took my last Ranitidine the night before my surgery and that's been it.  I'm almost back to a normal diet - you just need to be careful about portion sizes as you can't eat as much as before and chew everything very well.

I've been eating spicy food, had a few lagers, glass of wine - everything I couldn't do before - and no side effects!

My boxes of Gaviscon are gathering dust in the cupboard!!

Good luck, whatever you decide.

Sue

 

5

Hi Jack,

Have you thought of looking in to Endostim surgery as an alternative to a Fundoplication? 

However, that would have to be paid for as a private patient if done in the UK, and most Centres in Germany and Europe generally.

I also had a 5+cm hiatus hernia and a long and severe history of acid reflux. I was also VERY hesitant that a fundoplication would be the right move for me. I also had a lot of other gastric symptoms and even the consultant thought I might suffer worse from those after a fundoplication.

I eventually had a hiatus hernia repair, then an endostim implanted (at the same surgery), and two and a half years on am very happy with the result.

I would not have thought a LINX operation would be good for you due to your reduced swallowing capacity.

One of the amazing things about an Endostim is that it can be adjusted many times after the surgery, if needed, by a remote digital device to sort of "turn up the power" (not that you feel any of that!) if the initial setting is not getting as good as a result as hoped for.

Many of us have had lower than expected acid results on manometry tests, only to find they are MUCH higher when we have had 48-96 hour BRAVO tests. Given you have polyps and a Schatzki ring it sounds like you do have quite bad GERD, which is, essentially, a progressive disease, so an earlier intervention to try to restore the reflux barrier would be a wise move, as you are still quite young.

Anyway, just a thought. If you would like any more information do not hesitate to contact me

There is also a very active Facebook site called "Endostim Implant for Reflux", but also sites about Fundoplication and LINX, where you could "chat" to people about your concerns and hear more from people with similar experiences to yourself.

Kind regards, Nigel

 

Moderator comment: I have removed the email address as we do not publish these in the forums. If users wish to exchange contact details please use the Private Message service.

6

Thanks very much for your reply Sue, its always good to hear positive stories.

7

Thanks for the suggestion Nigel, I have joined some Facebook groups to ask questions. I know very little about Endostim, but it sounds very interesting, with much fewer side effects. But as it is a new procedure, there is always the small worry of what will the long-term prognosis be? Along with the cost compared to getting fundoplication on the NHS. It feels very difficult making a decision on what to do.

8

I don't understand the issues people have with the thought of fondopluication surgery. It's one day, minimal invasion and works.

Some people on here have been suffering for years and won't consider it - each to their own, but it was the best decision I ever made.