Laparscopic Nissen Fundoplication and Hiatal Hernia repair surgery

I had suffered with stomach problems for what felt like forever but was probably just a year or two before I finally insisted on seeing a specialist (Nov 13). I have previously been taking Esmaprazole, Domperidone and copious amounts of Gaviscon to no real avail. I suffered acid problems and a constant burning sensation in my upper abdomen. I had Laparscopic Nissen Fundoplication and Hiatal Hernia repair surgery in June 2014 and could feel the improvements from the moment I came round from Anaesthetic.

I thoroughly researched the surgery, recovery and surgeon’s available and even considered paying privately if the need required. By request I was referred to Mr Viswanath (James Cook University Hospital & Nuffield Hospital – North East England). After reading some of the blogs and information available on the Internet regarding this type of surgery I was under no illusions that the recovery would be very tough, Indeed my own GP advised me against this type of operation as did most of my family and friends however the pain and suffering was to such an extent that I knew I had little option but to undergo surgery.

I am very pleased to say that for me, the recovery has been less difficult/painful than I was advised, I put this down to two factors; firstly and most importantly the skill of the surgeon, secondly by being mentally prepared (remember that any discomfort and dietary restrictions after the operation are a temporary measure in order to fix your stomach, and by comparing that to the constant discomfort I was suffering Pre-Operation encouraged me to be positive each and every day).

I had never before experienced a hospital stay or surgery or anaesthetic and was very nervous however I can honestly say (to date) the hardest part for me was the thorough testing carried out to check if I was suitable for surgery and also the 24 hour fasting/dietary restrictions pre-op (an empty stomach for me was a truly painful thing - the acid was unbearable).

My surgery was first of the day and I was given the anaesthetic at 07:50, When I awoke from anaesthetic at 10:50 I was asked how I was feeling etc and if I was in any pain/discomfort, I wasn’t and asked for some water which I was given at hourly intervals on an incremental basis. After my first sip of water I managed a small burp (for me this was a major sign of the surgery’s success, I had read many blogs in which people were never able to burp again and therefore suffered from gas). I wasn’t in any pain/discomfort nor felt groggy in any way, in fact the constant nagging pain that I had felt pre op was gone. I managed to visit the ladies without any assistance walking and was discharged shortly after 17:30pm the same day. Amazing!! Unfortunatly another lady in for surgery the same day as me was not so lucky, when she awoke she asked for pain medication and when I left she was still struggling to swallow even the smallest amount of fluid. (I put this down to the pain medication but I’m not medically trained and am not qualified to say).

I was discharged with Tramadol pain killers to be taken as required alongside paracetamol, anti-sickness medication and Lanzaprazol (all dispersible). I took half of the Tramadol on the second day thinking it would help me sleep as I was finding it difficult to get comfortable lying down because of the wounds, but it didn’t and so I didn’t take any more. The first few days I took paracetamol every four hours along with the anti-sickness and Lanzaprazol but around day 5 I didn’t feel the need and only kept taking the antacid at doctors instructions (so the stomach has time to heal without acid causing any problem).

Food was limited to liquid only and I admit to following the dietary information very comprehensively (My advice if you want it - this is your chance to fix your stomach – don’t waste it by trying to run before you can walk). I kept a daily log of my food intake and although the first few days I managed very little, a small amount of yoghurt, ice cream and soup this soon increased as the week/weeks went on and the food diary helped me to monitor the improvement easily – which also helped boost my moral/positive attitude. Although a liquid diet sounds very restrictive, a little preparation can go a long way to making this diet easier and more acceptable. I made several batches of soup pre op, different flavours and thickness and froze them in different quantity pots – labelling them clearly, I bought several types/flavours of ice cream, and yoghurt’s and also drinks e.g Bovril, Hot Chocolate, Ovaltine and Horlicks and used full fat milk. I bought various tins of deserts e.g Custard, Semolina, Tapioca, rice pudding and thinned these down with full fat milk. By week 3 I was managing small amounts of soup with small bits and also a rusk with a cup of tea. After week 6 I stopped recording my food intake and continue to increase my intake on a slow and steady basis.

I’m not saying the recovery has been easy and there were/are times when it is difficult to swallow food and I know I still have a way to go, it’s still early days and as my intake is reduced so is my energy levels but in all I would say this was not as difficult and unpleasant as I had thought, and for me it was a big success and my life is much better for it. I am thrilled with the results to date (11 weeks on).

I would like to mention that I am pleased with the service received from the National Health Service, from the point of referral, through consultations and thorough testing to the date of my surgery took under 7 months. I couldn't fault the care received. Again I would mention the skills of Mr Viswanath and his team in helping to give me back my health.

My advice to anyone suffering - If surgery is a viable option for you then do your research & choose your surgeon, remain positive and follow the instructions given to aid your recovery. Don't be put off by the information available, there are success stories too. Best Wishes, Julie.

Hi Julie,  thank you,for such a comprehensive post. I have recently had the LINX PROCEDURE and like,you I'm feeling fantastic, my surgeon is one of the best upper GI consultants in Europe Mr Wajed at the royal Devon & Exeter hospital

i was offered LINX after many and lengthy tests and the critaria is so very strict. The nissen flux was mentioned but to be honest it frightened me for all the reso s you say, I also spoke to at least half a dozen people who had had it done and they all experienced problems, I totally agree it's down to th surgeon and to a lesser extent the patient, were all different. What scared me ref the procedure you had was how they hitch the stomach over the easophogus and also the inability to ever throw up 

I'm soooooo lucky I was able,to have the LINX procedure and he also repaired a 3 cm HH       Were both lucky it worked for us and hopefully we can help others who are maybe in the same position we were in prior to our respective procedures

 paul x

Julie, what a wonderfully positive report.  Bless you.  I'm so glad you are celebrating that good health that has been in at least part now returned to you.  

It's funny.  When I first came on these boards I was haunted by the many nay-sayers and the tales of horror that I continually read.  I was fearful of having an endoscopy.  I was literally shaking when I had my blood pressure in preparation for the same because of all that I had read here and elsewhere.  I was convinced I had something deadly.  I must - I thought- given what I had read.  

As it turned out IN REALITY I didn't.  I was fine.  

I was certainly much more relaxed when I had the colonoscopy largely because I knew better than to read - or believe - those ever multipling horror stories.  I prepared myself in a positive fashion on that occasion and was much better for it.

As you suggest, dear Julie, mind-frame makes a vast difference and I think - in part - only YOU can doctor yourself in that regard.  FORGET THE DRUGS AND POTIONS.  Certainly THAT proved true to me - and I can only share my own experience.  

Now, whilst it is true that all of my initial reporting symptoms have not disappeared entirely - albeit many have - I find I can now live happily aside them because I have become accepting of myself and continue to maintain a positive attitude.  The deficits may occasionally be disturbing, yes, but not life threatening and certainly nothing that I can't handle.  

There is, I have found, great succour found in the power of positive thought.  I sometimes wish there could be more of that hereabouts.  Bless you, Julie, for providing your own brilliant evidence of that same.  It gives great value to an ever burgeoning many.    

Hi Julie, really interested to read your post, I have seen my surgeon today and am booked in for  a partial nissen fundiplication, probably within the next month. I have a hiatus hernia and now barretts, have been on Omeprazole for 10 years looking forward to coming off this medication!  How long did you have off work following this procedure? Did you lose much weight following the surgery? My surgeon is concerned that I don't lose too much weight he said I am a very slim lady so mustn't lose too much. One thing I am concerned about is the inability to vomit afterwards, how do you prevent this if you get a bug and what could happen?  I absolutely hate throwing up but the thought of not being able to when your body wants to scares me!

Brilliant account of the surgery. Did they say how long it may last? I had the same procedures in 2007 but have had some savage reflux lately and my oesophagus is inflamed again. I'm in hospital just now waiting for a barium swallow. I would not hesitate to have the procedure again. It changed my life very much for the better.

Hi Sunlover, I was lucky enough to be able to do some work from home and to work as and whenIi felt able too, so only took 2 actual weeks off work, (I am self employed and so was able to do a phased return to work), i worked 9 hours in week 3 and 15 in week 4 and then built up gradually. I still get a little wore out from time to time but have just had a weeks holiday abroad which I managed fine without any problem and I have just started to do some light lifting, hoovering etc. I did loose weight and can't see how it can be avoided as you get full so quickly and need to re-train your stomach to eat and digest foods again. I suggest preperation as mentioned in my original post and tenacity ( I still struggle upon occasions with some foods e.g Bread ) and this can be most unpleasant but when this happens i simply eat softer foods - Yoghurt and soup were my saving grace or I also find it helps to start my meal with softer foods and work up to the more solid items e.g have a few mouthfulls of mash potato before I attempt meat. Keep trying to eat small amounts and keep a diary so you can mark you improvement. I too was worried about being unable to Vomit or burp for that matter, I have always had a poor constitution and would vomit quite easily before surgery. As i mentioned i burped straight away and have continued to be able to do so (I occasionally get trapped wind in my shoulders but it dissapates and isn't that frequent). I even managed to have a few small lager/beers on holiday without any problem. So far I haven't vomited nor felt the need too and long may it continue. I hope this info helps answers your questions. kind regards julie

Hi Caroline, They didn't say how long it would last, i'm just keeping my fingers crossed and being very sensible about how i treat my stomach. My surgeon advised that my stomach is now a single lane road instead of a dual carriageway and to treat it accordingly - which I fully intend to do. I am thrilled to date with my results and will do everything possible to help keep it that way. I hope you improve soon and let me know how you get on. Kind Regards Julie

What did you feel like after one week, reason for asking is, I am having the same op and 8 days later I have something in my calendar I don't want to miss, so will I be able to just sit there.

So glad you have recovered well after your op and thank you for your input

Can I just advise caution.  A friend of mine - a close friend - had this procedure a year ago.  Her reflux came back quite quickly and she three times went back to the operating consultant.  He assured her that wasn't possible.  The GP put her back on medication.  Then she found she was having laboured breathing.  They gave her a CT scan recently and a large HH had reopened leading to the development of a rapidly deteriorating situation with her lungs that is life threatening.  They now need to schedule re-constructive surgery.  I really would not have this procedure unless it is ABSOLUTELY neccessary.  My friend had it ... and it may well have cost her life.  Not pretty.  They have suggested she now has three years ... with potentially the need for a lung transplant.  Given her age (65+) she will not be a priority for that. 

Thanks for your comments, but I am suffering a lot.

however your comment on her age 65+ are you saying that at that age she will have to wait longer for her op. 

No, not for the restorative procedure.  That I would imagine is an emergency - even though she has to go through the emergency hoops.  (Oh, the system .. You know.)  It's just that - should it come to it - given her age - she will not be at the top of the priority list for a lung transplant should it come to that ... and that will have - in large measure - been wrought by the original Nissen procedure.  She SO wishes she hadn't had it.  I just got a text from her saying that the original operating consultant called just now to apologise.  That won't get her on the tube,  Blessedly the Freedom Pass does. ... LOL

Thank you, a very informative post, I'm due for my surgery in a few weeks and I've been dreading it, most people have horror stories but I'm going to remain positive as I desperately need this surgey to have a better quality of life.

Hello Julie , I've just read your story and can honestly say ive let out a sigh of relief, i have just entred the process, the surgeon has written to my GP saying i would benefit from this op , i know its not going to be a walk in the park , but if im going to eventually feel better and more comfortable than i do at this moments then it will be worth it , i will be 45 next week and all i can remember since a child is feeling sick after eating too much , acid acid and more acid , ive just changed from Omeprazole to Esomeprazole and find them better but still not 100% , if the process takes 7 months then im guessing my Christmas 2015 will be memorable. .. i hope by now you are enjoying eating lots of normal foods and feeling great , thank you ..

margaret.

Julie, thanks for sharing  your experience. It's helped me a lot ahead of my procedure on July 20th.

I have a large Hiatus Hernia meaning my stomach is a very long way from where it should be, and, somewhat rotated. I have been vomiting for about 12 months but I do have reservations about the op even though I can eat only small amounts of bland carbohydrates.

I was terified I had stomach cancer as I was diagnosed with Breast Cancer in 2003 so very relieved to hear the words " Huge H Hernia "    I didn't understand the complexities of the procedure then. I 

can go forward with a modicum of optimism now, thank you !

Wishing you all the best for ongoing good health.

Hi Julie,

Thank you for this. I must live in the same area as you. I have been referred to Mr Viswanath too. I have just had a Barium Swallow and Meal today which showed severe reflux and a sliding hiatal hernia. I have a feeling he will probably suggest a Nissen for me too. Iam very nervous about this, but its good to hear that you had such a positive experience under his care. How are you now? Where did you do your research ? Appreciate any help and advice you can give me. Thanks.

Hello Julie

Your post as been really helpful for me. I first read it 8 months ago when i was offered the fundoplication. After years of sufferring with heartburn, reflux and choking on food whilst sleeping, i decided it was time for the surgery. I aslo have hiccups daily, this has been going on years but the surgery is not garanteed to cure them

Well now i am day 2 post op. The op took longer than expected and i stayed overnight for observations. Im home now with codine, paracetamol and anti sickness meds. I have no problem swallowing. Milk shakes and thin soups going down easilly and i can burp!! I am in pain and very uncomfortable but i know that will soon ease up. Like you i am keeping a food diary and i shall follow my diet plan very carefully. Oh and 2 days with no hiccups which is amazing. I am looking forward to better health, thank you for writing such an informative post, it helped me make that decision.

regards

Janet

Hi

I have a hiatus hernia and also suffer with acid reflux. I have now been referred to see a surgeon could anyone tell me what happens at this first appointment with the surgeon and will more testa follow before they decide whether to operate or not?

Your initial consultation will be to discuss your condition and how he may be able to help.

He will probably ask for a surgical endoscopy. It's similar to a medical endoscopy but the surgeon will want a good look to see what he is dealing with.

The probable course of action will be to investigate or propose a fundoplication. This will require measurements to be taken of the pressure difference at the oesophago-gastric junction and a measure of the production and timing of acid levels. These are usually combined with the 24hr pH manometry test which requires a probe inserted via your nose for 24 hours. It's not that unpleasant and I can give you a link to the blog I wrote when I had this done a few years ago if you wish.

All the best if you proceed with the surgery. For me it was the best thing I ever did. All my reflux problems disappeared and i was off all medication.

Thank you for your reply. I'm not sure my symptoms are severe enough for them to do the operation but severe enough for me to be well and truly fed up of them. If you would send me the link for your blog that would be helpful if you don't mind. I have read a lot about the actually procedure but nothing about the appointments leading up to it so didn't really no what to expect.

Xx

Hi Julie, My name is shaqueta, I am 30 years old and I found out last year that I was diagnosed with Hiatal Hernia. My stomach is huge at the top like a basket ball sometimes it is hard for me to get around properly and be able to feel normal. I lack a lot of issues in self esteem because of this and I feel so depressed from time to time. I have an appointment this month on the 14th to go and and do my first follow up on it in another state. I know from the looks of it Surgery is needed, but I am so nervous and sometimes I feel alone thoroughly with this condition that i face each day. What is your advice on this issue?