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carskoti
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Quote carskoti Replybullet Topic: Fundoplication Surgery
    Posted: 17 Sep 2012 at 9:11am
Dear forum members,
 
I have been diagnosed as suffering with esophagitis in January. I was on 20mg omeprazole twice a day. I had a regular checkup in July and the consultant asked the i do a 24hour PH test. Around this time i relapsed as the Omeprazole was ineffective (no hearburn but lots of check pain all the time). I went back for the results and i was informed that i need to undergo surgery. I am really scarred. I am now on the surgery list. What is most gauling is that i do not have a complete picture of my symptoms i.e. Barretts Oesophagus, esophagistis (severe or mild), etc. I am due to see my GP on Wednesday and i want to know my options (second opinion, what other types of surgery is available, etc).
I would be most grateful if someone can help me with the following:
I have come across the Transoral Incisionless Fundoplications Surgery. Has anyone done this procedure? Has it been effective>
I read that once i have the nissen procedure, i cannot ever vomit or burp again. Is this true? What are the implications practically?
If i opt for the nissen procedure, is this for a lifes time or will i need to have it redone at some point?
 
Please please a quick response would be very much appreciated.
 
Thanks in advance
 
Carskoti
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bobgil
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Quote bobgil Replybullet Posted: 17 Sep 2012 at 7:12pm
I do know that Dr Elliott Goodman at the Nuffield Hospital, Leeds, offers the Esophy Transoral Incisionless Fundoplication.
They are claiming it is less evasive, because they do it endoscopically. Recovery time is much less. Don't know much about it?. Halo yes/ fundoplication No.
Seems strange to move straight to surgery, unless the PPI's are ineffective. Also, you could ask to see the detailed reports of your endoscope/ biopsy reports.
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Sandra W
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Quote Sandra W Replybullet Posted: 02 Oct 2012 at 4:16pm
Hi,
 
Sorry to hear you've been advised to have this surgery without anyone really explaining your options.  It sounds like you pH test has shown that you have a massive problem with reflux, so surgery might be the best option for you.  Even so, you are entitleed to answers and I think you shouls ask to discuss the situation further, ideally with the consultant, or at leat with your GP.
 
Well, most people are nervous about having operations - it's normal to feel like that - but I don't think you need to be scared, and I thinks you are probably feeling worse about the prospect of surgery because you haven't yet had an opportunity to discuss it with your consultant / dooctor and get your questions answered.  I hope your GP will be able to help.  If not, I reckon you should ask to ssee your consultant again to find out more - after all, if you are going to have an op, you are entitled to know why and what to expect.
 
As regards being unable to burp or vomit after the op, especially a Nissen fundo, as far as I am aware although this can happen in some cases it usually settles down as the area healing takes place.  Although I have read that some people have had longer lasting problems, but these are in the minority.  Chris (this site) has had a fundo and is pleased with it as far as I know.
 
I did see an article about TIF and it does seem to be very successful.  Also, it seems less likely to produce after effects that other methods of fundoplication.
 
As to the permanency of fundoplication, as far as I know many people are happy with the results in the long term, but fundos can loosen over time and some people do have them re-done or return to taking medication (e.g. PPIs).
 
I'm sorry I can't be more help and I definitely think you should insist on further discussion with your consultant / doctor before signing up for the op. 
 
Good luck, and let us know how you get on.
 
Best wishes,
 
Sandra.
 
P.S It might be helpful to google for TIF, fundoplication, etc as well.  Good luck.
E-mail: swilliams888@hotmail.co.uk
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Sandra W
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Quote Sandra W Replybullet Posted: 03 Oct 2012 at 10:59am
Hi,
 
Sorry I didn't get time yesterday (I don't have own computer - limited to 2 hours at library) to include any links, but these might be helpful for general information on some different types of fundoplication:
 
 
 
 
 
Also, you can read Chris's story abot his own funo at his site www.chrisrob.co.uk
 
These are just a very few of the sites giving info on fundoplication, so do have a look on google - having some background info can help you plan your questions when you see your consultant or GP.
 
I hope you get your questions answered soon and that you will be happy with whatever treatment you choose.
 
Good Luck.
 
Sandra.
E-mail: swilliams888@hotmail.co.uk
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chrisrob
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Quote chrisrob Replybullet Posted: 03 Oct 2012 at 11:50am
Hi Carskoti,

I'm glad Bob and Sandra have welcomed you and provided good advice and support. I've only just seen your post - not having received my customary notification for some reason.

There have been many attempts to produce methods of preventing reflux as alternatives to the Nissen Fundoplication though, to date, none have proved as effective.

The TIF procedure (EsophyX) looks promising and is a progression from the Endocinch endoluminal gastroplication whereby surgery is performed via an endoscope to plicate the lower end of the oesophagus in an attempt to reform the lower oesophageal sphincter (LOS).

The NICE guidelines for this procedure may be found by clicking on this link. It does have a higher failure rate than LNF (Laparoscopic Nissen Fundoplication) and NICE says: "this procedure should only be used with special arrangements for clinical governance, consent and audit or research."

Another endoluminal (via endoscope down oesophagus) therapy is
the Stretta Procedure using radio frequency (much like the HALO procedure for ablating Barrett's) to tighten the tissue at the LOS.

GUT (the BMJ gastroenterology publication printed this paper reviewing different endoscopic anti-reflux procedures a few years ago.

As Sandra has pointed out, my personal experience of LNF may be read here. (You'll need to scroll down the page.) It was right for me but may not be right for everyone.

But there is new hope with a new device called "Endostim" which is described as being like a pacemaker for the LOS. The charity FORT (Fighting Oesophageal Reflux Together) - a small charity based in Leicester with Prof Janusz Jankowski as an adviser, is looking for volunteers to take part in a trial of the system. Click here for more information. They only started advertising this yesterday.
If you do decide to contact them, please mention you were referred by Chris Robinson, chairman of Barrett's Wessex.

And let us know how you get on.

All the best

Chris
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