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Have a slipped Nissan fundoplication that has resulted in hiatus hernia. Sugested displaced stomach. What can be done?

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Gastroenterologist, Surgical
Practicing since : 1984
Answered : 922 Questions
I have a slipped Nissan fundoplication that effectively has given me a hiatus hernia of 1/2 of my stomach above the diaphragm & the other half below. This has been going on for at least 2 years with all of the pain associated with hiatus hernia plus slowed heart beat--cardiologist calls it a conjunctive beat (?) that is also very bothersome. My gastroenterologist suggested perhaps the displaced stomach is irritating the vagus nerve causing the heart issues and constant throwing up from food not going all the way down into my lower stomach (I guess). My surgeon has agreed to do surgery (this by the way will be the 3rd--1st Nissan failed & was re-done about 6 yrs later about 1989), but is unsure of how much scar tissue so what he will end up doing. He said worst case would be to treat me as a cancer patient & remove part (scarred) of my stomach & cut the vagus nerve. Best would be to fix the fundoplication & the hiatial hernia. My mother had 1/2 of her stomach removed years ago for bleeding ulcer & had vagus nerve cut and seemed to suffer no further to a ripe age of 90. I'm thinking that I'd almost prefer that over a 3rd fundoplication that may fail again. By the way, I'm 66 now, this all started at age 38 with a "severely narrowed & scarred esophagus" due to what we now call GERD. Should I get more opinions? Should I go ahead? Are there alternative procedures that can be done? I'm also now taking 4x the regular dosage of omoemprazole, so I'm thinking that cutting the vagus nerve would eliminate the need for the meds that obviously don't work that well anyway. Thanks for listening!
Posted Tue, 8 Oct 2013 in Abdominal Pain
Answered by Dr. Ajit Naniksingh Kukreja 6 hours later
Brief Answer:
Let the surgeon decide on table....

Detailed Answer:

Thanks for writing in

I appreciate your tolerance towards your situations and your understanding of your pathology. At this point, since both the procedure have it's benefits and side effects, the best option would be to let the surgeon decide on table as to what would be the best procedure. There are no other alternatives besides those two options offered by your surgeon.

Am sure he would have offered Laparoscopic surgery, this will give an option of exploring everything minimally and allowing to take a concrete decision on table

Vagotomy has its own inherent issues, though not very common. So best is leave it to the surgeon to decide on the table after looking at the XXXXXXX structures.

Hope this makes sense. I would be glad to discuss further if you need clarifications.

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