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Fundoplication

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URL: http://www.barrettscampaign.org.uk/forum//forum_posts.asp?TID=1805
Printed Date: 18 Oct 2019 at 11:18am


Topic: Fundoplication
Posted By: bobdigi
Subject: Fundoplication
Date Posted: 04 Jul 2017 at 8:04pm
Hi. I had my third scope today and the results aren't what i was suspecting.
For the first time i have been diagnosed with a hiatus hurnia. And the 3 cm Barrets apparently looked normal. But no biopsies were taken!!!!!
I'm 38 and otherwise fit and healthy so it has been suggested i have a Nissen Fundoplication which i think i'm happy about. In fact i was going to request it as i don't like being on PPI's and if it works well i can come of the PPI's and be reflux free!!!
Obviously i'm anxious about it but i think i'm going to go for it.
Is it bad that he never took biopsies? And He suggested that after the surgery i wont need any more scopes and biopsies of the Barrets. Should i request another surgeon if that's possible? Because it Sounds bad to me!!
Thanks, Bob.



Replies:
Posted By: jcombs99
Date Posted: 04 Jul 2017 at 8:45pm
Bob
No such thing as "NORMAL" Barretts it's called a pre cancer condition . U need a better GI start from zero spend some money ..

CHEERs


Posted By: bobdigi
Date Posted: 04 Jul 2017 at 8:53pm
Well by normal he means no displasia. Thanks. With respect i never find your comments much help. I either can't fully understand them, or you just keep bashing the NHS! I'm sure you'd like everyone to go private but we have the NHS and i'm not in a financial position to go private even if i wanted too. And yes i know if you relied on the NHS you'd be dead. And yes i know you don't think the NHS is good and yes i know we should apparently go private. But anything i have done, will be done on the NHS.
So thanks for your comments, but feel free to not reply to any of my posts in future as they aren't much help. Thanks.



Posted By: jcombs99
Date Posted: 04 Jul 2017 at 8:57pm
Good for you !! you keep posting and I won't reply .Lets hope it turns out as well for you as it did for me .Maybe save some funds you may need them in the future .

CHHERS


Posted By: steveb8189
Date Posted: 04 Jul 2017 at 9:30pm
Hi Bob

It is very strange he didn't take any biopsies as that is normal procedure. Was this endoscopy specifically a surveillance check for the Barrett's or to investigate the hernia? Checking the status of the Barrett's for dysplasia is the main reason for the surveillance! How do you know they took no biopsies? Any chance you were a bit groggy after the scope and didn't 100% follow what was said?

As for fundo - I'm 35 and in a similar position with HH but haven't yet convinced myself to go for it. I'm very active and get on well with the PPIs so don't see the benefit for now. Given the reward is so small they don't quite outweigh the (small) risks or side effects. Would love not to be taking the drugs though!

Fingers crossed you find my post more constructive!


Posted By: bobdigi
Date Posted: 04 Jul 2017 at 9:43pm
Well to be fair the scope was to see why i have had an increase in reflux. I only had gas and air and asked why he didnt take any biopsies. He said he will probably take some when i have the operation. So maybe there was some method! Perhaps he thinks it's best to take them when the hernia is repaired.
I will be having a consultation before the operation date so I will clarify then.
I'm also active play badminton, ride regularly and do a little weight training. I'm worried about having the op and suffering from problems which don't allow me to carry on with my activities. But on the other hand I probably reflux around 40 times a day. Sometimes acid, sometimes not. And I hate being on PPI's, so I will probably go for it.
Have you had any problems on PPI''S at all?


Posted By: steveb8189
Date Posted: 04 Jul 2017 at 9:45pm
Oh, I forgot a bit. If you have the fundo you will 100% still need to carry on with the surveillance... that last point does worry me a bit about your GI doctor. It may be worth asking a second opinion so get another referral from your GP.

I am lucky to have private health cover from work but I see exactly the same specialist as when I go on the NHS. Most doctors do both - you just have to wait longer for an NHS referral.


Posted By: steveb8189
Date Posted: 04 Jul 2017 at 9:47pm
As for refluxing 40 times per day I presume you mean so you can feel it in your theist? The topic is widely debated but most papers work to an estimate of 70 refluxes per day (into the eosophagus) being normal.

Have you had the 24hr pH monitoring?


Posted By: bobdigi
Date Posted: 04 Jul 2017 at 9:50pm
I edited last post! I thought/knew it should be biopsied in future. It is a little worrying. So I should go back to my GP and ask for another scope, or to meet another gi doctor? Thanks, Bob.


Posted By: steveb8189
Date Posted: 04 Jul 2017 at 9:53pm
I would just ask to see a different one. Sounds like you need the biopsies done so may as well try someone new! Where are you based? Someone in here may be able to recommend someone


Posted By: bobdigi
Date Posted: 04 Jul 2017 at 9:54pm
Well around 40 that I can feel coming right up to my throat. I have to swallow it back down. 40 is probably a conservative estimate.


Posted By: bobdigi
Date Posted: 04 Jul 2017 at 10:24pm
I live in Gosport and attend Portsmouth QA hospital.


Posted By: steveb8189
Date Posted: 05 Jul 2017 at 8:31am
Sounds like you're in the right part of the country then - I think Chris will be able to add something about the Southampton area


Posted By: bobdigi
Date Posted: 05 Jul 2017 at 9:34am
Hope so. Thank you.


Posted By: chrisrob
Date Posted: 05 Jul 2017 at 10:16am
Hi Bob,

Sorry for not replying sooner, I was busy getting ready for tonight's BW Annual Meeting. Will you be there?

If your scope was not part of the regular surveillance programme, they may not have felt it necessary to biospy since the concern was regarding excessive reflux rather than the state of your Barrett's.

My recommendation would be to go for the fundoplication. I was first offered it in 1997 (though it would have been by open surgery then and I was too scared). I do wish now that I had had it then. When I eventually succumbed, 11 years later, all the reflux concerns I'd had all my life (many of which I hadn't realised were reflux) went overnight.

If you do proceed to have fundoplication, although I am sure there are good surgeons at QA hospital, I believe Southampton has the best, if you are able to ask for a referral (which you have a right to under NHS) to Jamie Kelly (who invented the laparoscopic technique for oesophagectomy for those developing the cancer) or Jim Byrne (who did my Collis-Nissen revision when my original fundo came loose from 5 hours violent retching with norovirus).

Before a fundo, in the work up, you would receive a surgical scope. As far as you are aware, it's no different from a medical scope but they need to examine the junction and the fundus from inside the stomach to assess the procedure they need to adopt. They may or may not normally take biopsies during a surgical endoscopy as that's not their focus, but if you make them aware you may have a concern, they can do that at the same time.

It can take a lot of waiting to get things done on NHS as your surgery would be classed as "elective" which puts it below "essential" or "emergency". I had to nag a few times to get my case progressed. (I won't go into my anger at the decimation of what was the best health service in the world by our "so-called" government!)

Apart from an endoscopy, they'll also want to measure the pressures over your Gastro-oesophageal junction and your acid levels by 24 hour pH manometry.

In the meantime, you may read patients' experiences of fundolication (and of 24hr pH maonmetry) on the Barrett's Wessex website https://sites.google.com/site/barrettswessex/home/patient-experiences#TOC-Fundoplication - here .

All the best
Chris

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http://www.barrettswessex.org.uk - www.barrettswessex.org.uk


Posted By: jcombs99
Date Posted: 05 Jul 2017 at 12:12pm
Chris
    That's why u don't want the Gov running Healthcare .Obama took 1/2 Trillion Dollars away from Medicare (65+ only) and gave it to illegals to help with their care .Where do the retired get the funds to make up the difference ??


Posted By: chrisrob
Date Posted: 05 Jul 2017 at 12:23pm
Sorry Jeff.
Completely disagree. Our NHS was born 69 years ago today when the UK was in real austerity post war. It has saved countless millions of lives.
The UK spends about 1/3rd per capita on health care than the US yet it was listed best in the world a few years back when US was in 10th place.
I am constantly corresponding with dozens in US on Facebook whose insurance won't cover their medication etc and who cannot afford what they have been told they need.
Unfortunately our present government is intent on destroying the health service.
But don't knock our NHS. It's like walking into a mosque and decrying Allah or telling a devout Catholic that God is a myth.

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http://www.barrettswessex.org.uk - www.barrettswessex.org.uk


Posted By: jcombs99
Date Posted: 05 Jul 2017 at 12:37pm
CHRIS

Those people didn't plan ahead like I did just 42 years ago . The Biggest pro Obamacare was Obama and he turned on the middle class when they couldn't pay HIS price but gave to the poor for free .I like ur system over there not over it . Ur wait times are insane ur doctors come here for better pay and less taxes. U do what we did VOTE then out of office .
    The US never travels to the NHS to get healthcare but u travel here why is that ?? Because they want to spend more money !

Fire Anyone or Better Healthcare for everyone !!

CHEERs [IMG]smileys/smiley32.gif" align="middle" /> [IMG]smileys/smiley32.gif" align="middle" /> [IMG]smileys/smiley32.gif" align="middle" />


Posted By: bobdigi
Date Posted: 05 Jul 2017 at 8:22pm
Hi Chris no i wont be there. I would like to attend a meeting soon though. I'm not fully aware what it entails but i'm interested in coming along.
The GI doctor said initially he was going to do a test which measures my ph levels, but after the scope he said it probably wasn't worth it and he would request funding for the Nissen.
In fact i have the report here and it reads...

"Plan- He would be an excellent candidate for surgery and i will apply for PAT tool funding and bring to clinic to discuss further. Reflux surgery explained and leaflet given. I don't think needs barium or PH as everything is in alignment."

Its written by Nicholas Carter, endoscopist. I think i will take your advise and request a referral to Southampton.
Do you think it will lesson my chances of Fundo if i change to another Gi Doctor? as i'm quite keen to get it done and i don't want to scupper my chances!!!!!

He implied the surgery was for certain, but after reading the report, the PAT funding request makes me a little concerned. Or do you think he knows it will be granted.

Sorry for so many questions. I know you are busy. And probably not psychic!
                           Thanks, Bob.


Posted By: bobdigi
Date Posted: 05 Jul 2017 at 8:24pm
I didn't think your were going to reply to my posts Jeff! You never lasted the a day!


Posted By: jcombs99
Date Posted: 05 Jul 2017 at 9:11pm
Read My Post again I responded Chris not u lets see how u last in the NHS . Read the other posts Lots of Happy NHS users out there I wonder why


Posted By: bobdigi
Date Posted: 05 Jul 2017 at 9:41pm
it's still my post lol. I assume you profit in some way from private healthcare system. Which is fine. But why are you so obsessed with insulting the NHS? If it wasn't for the NHS i wouldn't know i had Barrets in the first place!
Why spend your time insulting the NHS and discrediting it when you could spend your time promoting private healthcare in the states?
Rather than being negative about something that doesn't concern you, why not be positive about something that does!
The NHS is far from perfect, but private healthcare isn't either. So worry about fixing that rather than insulting this.


Posted By: jcombs99
Date Posted: 05 Jul 2017 at 9:55pm
BOB
   Go read Chris's book then u will need to ask few questions . The NHS is trying to pass off their LOW standards to the UK which are much cheaper to do then what the US healthcare can do .I could care less if a person has private or NHS ins as long as it's good care which it isn't .When ur done with ur mess tell all about the care ur getting and I'll be happy to tell how quickly and I bet better treatment the US NHS gives .The Gov (NHS) here pays for 60% of all healthcare in the US me too after 65.
   Their pissing down your back and telling you it's raining . I get it do U ?

Always positive

Jeff


Posted By: bobdigi
Date Posted: 05 Jul 2017 at 10:16pm
It's irrelevant to me if private healthcare in the USA is better than the UK NHS. I don't live in the USA and i can't go private. So what good does it do telling people how much better off they would be living in the states with private healthcare, when they live in the UK and use the NHS?
I don't want to ask for help and advise and get your negative useless feedback and i'm sure i'm not the only one. So i wont be replying to any more of your posts as i don't want to encourage you. And i can't stop you but i'd be glad if you didn't want to reply to my posts or leave any replies on my topics. Perhaps go on a private insurance forum and conversate how superior it is to the NHS! The NHS isn't perfect and the current government isn't helping. But i assure you, neither are you on here.Thanks, Bob.


Posted By: chrisrob
Date Posted: 06 Jul 2017 at 8:54am
I'm back.

Sorry was busy with Annual meeting and so tired when I gt home went straight to bed and slept.

Let's not turn this forum into an argument about health systems in UK and US. It does rather detract from this forum's purpose.

Bob. You missed a good evening but I'll post about it later. But I have a https://sites.google.com/site/barrettswessex/activities/southampton - drop-in session this afternoon so some of the carry-over tasks from last night may have to yield for another 24 hours.

I'm sorry but I'm not sure what "PAT funding" is. If surgery is warranted, the normal protocol is for the consultant gastro to write to the surgeon and request he see you.
NICE recommendations usually require a pH24 hr manometry to test pressures and check on acid so as to ensure surgery is not provided inappropriately.

If you wish to be referred to Southampton, I would suggest contacting Nicholas Carter and asking him whether he can refer you there. Your referral will be to the surgical team rather than the gastroenterology team.


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http://www.barrettswessex.org.uk - www.barrettswessex.org.uk


Posted By: bobdigi
Date Posted: 06 Jul 2017 at 10:00pm
OK thank you. I received a letter today which was quite impressive and I have a meeting on the 18th July with someone from the surgical team. I'm actually going away for the weekend but when I get back Monday I will enquire about getting a referral to Southampton. Thanks again for you help and advise.


Posted By: Merl@2018
Date Posted: 21 Feb 2019 at 5:41am
Hi Bob, I know it's been more than a year since your post. I just want to ask re: ur fundoplication, has it been well so far? Have u stopped using PPI's? Do you still go for follow up scopes? I am deciding re: having a fundoplication,too. Many thanks.


Posted By: bobdigi
Date Posted: 21 Feb 2019 at 7:10am
Hi Merl. Yes I had the operation at Portsmouth QA hospital in October last year. And I'm glad to say it was a complete success. I haven't had one bout of heartburn since. I can burp properly. And I no longer take ppi's.
Apart from the fact I get no heartburn,I can't even tell I've had anything done.
My advise, if you have the opertunity, is get it done.
I haven't had a scope yet since the operation. Feel free to ask me any questions! I haven't had a scope since the op. I will chase it up if I haven't heard anything by October this year.


Posted By: Merl@2018
Date Posted: 22 Feb 2019 at 6:56pm
Thanks Bob, Yes, my GI has mentioned fundoplication however, I am quite anxious to go through the procedure. Was ur symptoms that bad? Or do u think having fundo early would be the best option rather than on a long-term PPI? Thank u.


Posted By: bobdigi
Date Posted: 22 Feb 2019 at 8:13pm
Well I believe ppi's to be much more harmful to one's health than we are led to believe. So yes I would definitely recommend operation over lifetime on ppi's.
But that is only my opinion. And I may be wrong. But the way I see it, we need stomach acid. It's what digests our food, and allows our body to break down vitamins and minerals so we can process them.
Without that process working properly, I don't believe optimum health is possible. After all if humans and animals didn't need the correct amount of stomach acid, then that amount wouldn't be there in the first place.
However, for people who can't or won't have the operation, ppi's are possibly the next best thing. However from the research I've done, ppi's don't offer much protection from barrett's turning cancerous anyway! They should however prevent anymore of the oesophagus cells turning to barrets in the first place.
But my advise would be have the op. My reflux was pretty bad. I had food and liquid regularly coming up to my mouth and I had to swallow it back down.
On my last scope, I told the Dr I believe I have a week valve and that my problem was mechanical. He told me I must have a hiatus hernia. And that almost everyone with barrets has a hernia. After the scope he said there was no hernia. And that he thinks I was right, it is mechanical.
Because I'm not overweight, don't smoke or drink, and have tried ppi's with no effect, that I would be suitable for an operation.
I was scared to have it done. I read all the horror stories online. But a lady on this forum was very supportive. And she gave me the courage to go for it. It was a great decision.
When you look online you will see so many people with bad experiences. And sure, surgery has always got the possibility of going wrong. Or being a dissapoitment. But for the vast majority of people, things go right. And they are happy with the outcome.
The difference is, these people are not online telling everyone how great their operation was. They aren't on forums looking for help. Only the people who it wasn't a success for are online typing their experiences.
If you are overweight, drink too much and don't try to help your heartburn with your lifestyle, then maybe don't bother.
If you try and stay fit, aren't overweight, don't drink loads and don't smoke. Then go for it.
I had a partial fundoplication. And it has worked out brilliantly. I can burp, I have no pain, no heartburn and no ppi's.
It isn't painful. Although the trapped air in my diaphragm was very uncomfortable for a couple of weeks. But it was a small price to pay.
How old are you and have you tried controlling heartburn through lifestyle changes?



Posted By: Merl@2018
Date Posted: 22 Feb 2019 at 8:39pm
Hi Bob, thank u for the advice. I have been on esomeprazole 40mg/day for 8 mos, Lanzoprasole for almost 2 mos but despite that, I am tasting acid everyday . I wasn't having this much symptoms before I was on PPI. I am worried that my Dr might increase the dose which I think will not be helping. I feel that the acid is just directly spilling all over my esophagus to my mouth. I'm scared to have fundo but I think thats gping to be a better option rather than in a high dose of long term ppi . I asked my GP what she thinks and she told me that fundo will weaken the sphincter all the more which will be more detrimental,but then again thats what she thinks. My GI specialist only told me abt risks of dysphagia and other side effects. How long will be the waiting time for the op to take place? I am 42 y/o, not smoking, not drinking. I am slightly overweight after giving birth 3yrs ago..I am watchinh what i eat, stopped drjnking coffee ,etc but still tasting acid in my mouth.


Posted By: bobdigi
Date Posted: 22 Feb 2019 at 9:17pm
So I'm assuming you have barrets oesophagus? As far as I understand, ppi's can cause more reflux than before. Simply due to the fact by diminishing the amount of stomach acid, food is finding it harder to digest, hence staying around for longer and causing reflux. In theory, this stomach reflux shouldn't burn if the ppi's are doing there job in dramatically reducing stomach acid. But it could be more often.
Remember there is a difference between reflux and acid reflux. Another possibility is what you are tasting isn't stomach acid. It could be bile. Ppi's won't help with bile. And with less stomach acid your body could be producing more bile to help the digestion process.
Either way, if you have barrett's and bile or stomach acid is still burning your barrett's, oesophagus and throat, that isn't good.
Ppi's will only be less effective over time. So have it now while your still young. Why wait till you're older? And when you're older it probably won't even be an option!
Ask the surgeon what your doctor is on about. Perhaps the valve does weaken. But after tge op you won't be relying on your valve to keep the contents in your stomach anyway. But perhaps it does still play a role. I'm not sure.
Either way it stops acid leaving tge stomach, so who cares.
What are you afraid of?


Posted By: Merl@2018
Date Posted: 22 Feb 2019 at 10:38pm
Yes, I have barretts, diagnosed 5 mos ago. I am scared of the procedure, side effects and the fear of maybe it will not work, etc. I know I have to make the decision now rather than wait until it gets worse. Thanks


Posted By: chrisrob
Date Posted: 22 Feb 2019 at 11:14pm
There's so much rubbish propagated about PPIs.
Read the risks including all the research, in https://docs.google.com/viewer?a=v&pid=sites&srcid=ZGVmYXVsdGRvbWFpbnxyb2JpY2hyaXN8Z3g6NzI3ODA3NTg3YzY2YThmOQ - this excerpt from the newly revised Down With Acid book about to be sent to the printers.

If you prefer read this article, https://www.medscape.com/viewarticle/903378_3 - Adverse Effects of Proton Pump Inhibitors: Fact or Fake News? .
“When PPIs are prescribed appropriately, the benefits greatly outweigh potential adverse effects. The absolute risk to an individual is extremely low (less than 1 in 500) and fear of these risks should not dictate prescribing habits. … Not only has the information derived from these observational studies been unhelpful, but also the unattended consequence is that patients who require PPIs to prevent UGI bleeding are not receiving these medications, mainly due to fear on the part of the patient and provider.”

However, although great at reducing acid https://sites.google.com/site/robichris/barretts/prevalence-paper - they do not reduce reflux , just make it less damaging.

https://sites.google.com/site/downwithacid2/home/reflux/reflux-reduction/fundoplication - Fundopication surgery is the best way to manage reflux if https://sites.google.com/site/downwithacid2/home/reflux/reflux-remedies - lifestyle modification doesn't work.

I was offered the operation back in 1999 and delayed 10 years before I had it because I was scared. I wish I'had it sooner!

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http://www.barrettswessex.org.uk - www.barrettswessex.org.uk


Posted By: Merl@2018
Date Posted: 23 Feb 2019 at 4:55am
Thank you, Chris and Bob for your kind replies and information given. I will discuss with my GI om my next appointmentn. Chris, I am living in Berkshire - do you happen to know any surgical team around here who does the fundo? Will it be a long waiting procedure as to when it will be done?
Many thanks.


Posted By: bobdigi
Date Posted: 23 Feb 2019 at 7:14am
Hi Chris. I wasn't trying to scare anybody off ppi's. It's just my personal view that ppi's do effect the stomach and intestines, which then effect the natural gut flora. Which in turn can effect a person's overall health. But as I stated its only my opinion.
Perhaps they have no effect on gut flora, bacteria or fungus. But it's just my opinion they do.
Either way Merl I would suggest going for the op. The two things I worried about was damage to the Vegas nerve something else (I can't even remember what the other thing was now). The surgeon did tell me the statistics of damaging the Vegas nerve. And it was very low. And he told me the risk of the other thing was so low it wasn't even a concern. He even said its only something that sometimes happens in America!
Speaking to the surgeon really put my mind at rest. So I would definitely advise atleast getting a referral to speak to him.
I was in and out the same day. I just have five small scars.
No pain, just uncomfort for about 10 days. But that was more due to trapped gas. And from what I have read it doesn't usually effect people as much as it did me. The stomach area just feels tender when moving around. But all the time you're sat down doing nothing, it's absolutely fine.
If my fundo came lose I wouldn't hesitate to have it done again. It really is no big deal!


Posted By: chrisrob
Date Posted: 23 Feb 2019 at 11:14am
Hi Merl,

http://thamesvalleygeneralsurgery.com/team/mr-michael-booth-ma-frcs/ - Michael Booth is the upper GI surgical consultant at Reading. Although I have heard of him, I don't know him.
From my own experience, I can recommend the surgeons at Southampton but I'm sure Michael Booth is probably very good.

I had two fundolications at Southampton under NHS. Unfortunately the surgery is classed as "elective" which means it's placed on the lists below "emergency" and "essential" meaning it can take months of waiting. (I had to wait 9 months each time.)

You may read patients' experiences of the operation https://sites.google.com/site/barrettswessex/home/patient-experiences#TOC-Fundoplication - here and my blog about my Collis-Nissen revision surgery (after my wrap became loose following 5 hours violent retching due to norovirus https://sites.google.com/site/robichris/barretts/refundo - here .

The surgeons Jim Byrne and Jamie Kelly at Southampton prefer incorporating the Collis procedure when performing Nissen fundoplication to provide for a more permanent wrap. It resections the stomach to effectively provide a longer oesophagus to make for a better wrap.

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http://www.barrettswessex.org.uk - www.barrettswessex.org.uk


Posted By: Merl@2018
Date Posted: 23 Feb 2019 at 12:55pm
Thank u Chris,I am under Mr Bob Zoin as my GI consultant, not sure if u heard of him or not sure if he will be doinh the fundo,too. He said that if fundo is to be done, he will refer me for ph test in Reading. I will know some details maybe on my next appointment next week. I am getting more anxious everyday due to so much acid in my mouth constantly-some days are better than others but its constantly there. I just wonder if there are any other causes of this so much acid spillage. If there are there other organs actively secreting all this acid for some reason or its just mrchanically due to weak sphincter. It can make u go crazy thinkinh and feeling all these. Many thanks for the information.


Posted By: chrisrob
Date Posted: 23 Feb 2019 at 1:11pm
Don't know him. Googled him. Seems OK.
Acid is produced in the stomach. If you're getting it in your mouth, it must be refluxing there.

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http://www.barrettswessex.org.uk - www.barrettswessex.org.uk



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