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Tcb63
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Quote Tcb63 Replybullet Topic: ? Surgery / dismotility
    Posted: 23†Oct†2018 at 5:24pm
Hi this is for Chris as your knowledge is second to none
Iíve been to see two surgeons in the last 3 months today I saw the top surgeon at Leeds , Iím totally at a loss what to think . First surgeon told me I have dismotiliy and a OP was a no , today Iím told the ph tests and 24 hr study show no dysmotility and a normal functioning LES and marginal refulx and that even though Iím still refluxing and in pain the OP might not work for me . He also said if tablets were working they prefer to do the OP as results are better than if the tablets donít work . This I donít understand at all as my thoughts were if your still refluxing with meds then the OP would be the best option . Iíve got a 2cm hiatus hernia and C0M1 Barrettís that was back in February when I was diagnosed after my endoscopy , by the way my path report was clear for intestinal metaplasia, dyslaysia and malignancy I posted that back then . Any way the surgeon has given me six weeks to decide if I want the OP or not as he did say he can do it but canít guarantee the results as it can cause other issues . My question is Chris I thought the OP was the option if refulx was still there with meds not the other way round as in no refulx with meds .
Donít know what to do for the best any feed back would be much appreciated and I know in the end itís my dessision .
Thanks Tracy
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chrisrob
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Quote chrisrob Replybullet Posted: 25†Oct†2018 at 9:34am
Hi Tracy,

It is true for some reason they think that if PPIs work, it makes you a better candidate for surgery. I'm not too sure of the rationale though did have it explained to me once. I guess it's something like having confirmation that it's the acid reflux that's the problem, rather than a dysmotility issue keeping the food bolus in the oesophagus, so if stopping one factor works (ie the acid) then stopping the other (ie the reflux) will be effective?
The other school of thought says the surgery is a "last resort" to be used when PPIs are not resolving the issue.
The argument I have used, and discussed with the premier gastro professor from Cambridge, is that if acid symptoms are most prevalent (eg heartburn oesophagitis), PPIs are the most appropriate treatment and if reflux symptoms are the worst (eg cough, throat clearing), surgery should be considered.
(See my paper, Prevalence of Extra-Oesophageal Reflux symptoms amongst acid refluxers and perceived efficacy of regular medication and reflux reduction intervention..)

The issue is motility. Since the wrap will realign the muscles of the lower oesophagel sphincter and effectively make it harder for the backwards passage of material through it, it will also restrict the flow of material to the stomach, thus requiring good peristalsis.
The body produced Barrett's cells as a protection against acid erosion. It can also try to reduce reflux by tightening the oesophagus and reducing motility.

Your Hiatus Hernia is probably the main cause of your reflux. It misaligns the muscles of the lower oesophageal sphincter impairing its function. (See this simple description.)
2 cm is a reasonably short HH.

Your Barrett's is also very small. c0m1 means there is no complete collar of Barrett's and the tongues are less than 1 cm. However, surgery is not seen as being an action against the Barrett's but against the reflux that in part caused it to develop.
(The size and type of your Barrett's (ie gastric rather than intestinal) actually means some wouldn't actually classify it as Barrett's at all.)

There are many trains of thought regarding surgery vs medication.
This study, Nissen fundoplication vs proton pump inhibitors for laryngopharyngeal†reflux†based on pH-monitoring and symptom-scale, concluded, "LNF [Laparoscopic Nissen Fundoplication] achieves better improvement than PPIs for LPR with type I hiatal hernia", whilst in the guidelines for diagnosis and management of Barrett's esophagus from the American College of gastroenterologists, it says, "36. Antireflux surgery should not be pursued in patients with BE as an antineoplastic measure. However, this surgery should be considered in those with incomplete control of reflux symptoms on optimized medical therapy (strong recommendation, high level of evidence)."

There ever is a clear answer. There are two alternative camps. Most gastroenterologists are medics and prefer to manage symptoms with medication. Surgeons prefer to operate.
I just know, after a lifetime of relux symptoms (most of which I hadn't realised were associated with reflux at all - eg ear problems etc), and having been on increasing levels of PPI medication which had stopped the heartburn & oesophagitis discomfort but done nothing to stop the debilitating cough, I am very pleased to have had my op: it gave me my life back.

But there is always the chance the surgery may not be as effective for you. As with all surgery, there are risks and possible complications making swallowing more difficult or reducing the ability to vomit but if you have a good surgeon, risks are minimised.

You may read others' experiences of the operation on the Barrett's Wessex website
here.

I hope this has helped your decision.
All the best,
Chris
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Tcb63
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Quote Tcb63 Replybullet Posted: 25†Oct†2018 at 9:52am
Hi Chris
Thank you so much for explaining all this to me itís been a long 12 months of feeling unwell and trying to find out the best options for me as Iíve previously said Iíve tried every med there is with no relief and surgery is my last resort . I now need to sit down and seriously consider the OP ,for me I feel itís my only option as I donít want to be in constant pain daily. I wonít say Iím not scared I am but if it helps it would be worth it .
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Quote Tcb63 Replybullet Posted: 31†Jan†2019 at 11:07pm
Hi Chris
Just an update on my journey to NF going for pre OP on Saturday then onto list for surgery . Iím really anxious but just want to get it over with and start my road to recovery. Any tips to help me get through the healing process would be much appreciated so I can prepare myself well in advance for when I get my surgery date .
Thanks in advance Tracy
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Quote chrisrob Replybullet Posted: 01†Feb†2019 at 10:54am
Good luck, Tracy.

Hope you don't have to wait too long between this appointment and actually receiving the surgery.

Food. I lined up a number of tins of soup and creamy deserts beforehand. Try to think, "Would it pass through a drinking straw?" You will feel full quickly and typically could lose over a stone so don't stint on the calories. It's the time to indulge in your favourite sweet treats.

Exercise. Your body needs to rebuild stamina. I set myself small incremental daily targets. Can I walk (slowly and carefully) to the lamppost? Can I walk to the corner? (Remembering, of course, you have to walk back.) It may take a few days until you're comfortable walking round the block (depending on the size of the block that is). But don't try anything too strenuous too soon (eg weight lifting). This is the time to play the invalid a bit if you have a partner who can do all the chores.

Best Wishes
Chris
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Quote Tcb63 Replybullet Posted: 01†Feb†2019 at 12:35pm
🙂thanks Chris
Iíll keep your tips in mind Iím a tough cookie as Iíve had lots of surgeryís in the past . Iím lucky as my hubby has retired so heís on hand 24/7 Iím sure heíll do his bit . The sweet treats will be on my list for sure canít afford to loose to much weight as Iím a skinny minny anyway fingers crossed I donít loose to much . Just hope everything goes to plan .
Iíll keep you posted with my progress when itís over hope Iím not waiting too long thatís the worst bit .
Thanks once again Tracy
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