I'm new to this forum. Live in Texas and have had achalasia for 16 years. It is now so bad that I need surgery. I'm desperate!!! I wrote up a few questions to ask my surgeon at our consultation on June 5 and wonder if some of you with more experience having had a Heller Myotomy with fundoplication could add other questions. These are mine:
1. What type of fundoplication do oyou perform with HM?
2. How many HMs have you performed?
3. What is the success rate of your patients?
4. What are possible post-surgery side effects?
5. How long does the surgery take?
Many thanks for your input.
How do you know this is the right surgery Fundoplication I assume, that I need? How many have you performed? What was the success rate? Am I a candidate for less invasive procedures? The list is endless.
One last thing Maya . When you ask how many he has performed please ask him to give the number he personally did and not ones he watched or assisted on. It could be a huge difference.
All doctors have a different diet plan before and after . Mine had me on clear liquids for 3 weeks before my poem. After surgery it was 3 weeks on clear again then 3 weeks on full liquids then 3 weeks on soft foods and then slowly got back to my regular diet but I lost 25 lbs and the clear liquid diet it rough especially for 3 weeks so just ask your Dr.
Thanks for starting this topic. Since I too am new here, I coulnt help with your question. I'd really appreciate though, if you could please share your experience as how to mange it for so long, what were the things that helped you during all those years? Giving the fact that this can't be cured even with a surgery and the effect of a successful surgery could also only last for 10-20 years, in best cases, I'm just wondering if it's best to manage it as long as possible before get operated, as it most likely result in acid reflux for most of the patients. Any thought?
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.
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.
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 prevıous 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
I think I would start with asking for an explanation of exactly where the problems are occurring in your oesophagus (this should be clarified with high resolution manometry) and the length of the muscles that the surgeon intends to cut.
What condition is your oesophagus in generally, or has it become baggy and lost its natural tone and resilience?
Then it is a matter of how far the fundoplication will be wrapped around to deal with reflux.
When your talking esophageal Alchalasia, it's already understood that the esophagus has lost its tone and has an excessive amount of turgor. Rather it be a partial wrap, or a full wrap (which is usually not done,) most likely the patient is going to experience GERD. Often though after healing, the GERD subsides. But you can almost be guaranteed some acid reflux on any Fundoplication that they do.
Good Luck!
DWRN
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.