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Dr. Andrew Rynne

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Is Nissen fundoplication surgery an effective treatment for GERD?

Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 16895 Questions

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Posted on Fri, 14 Dec 2018 in Abdominal Pain
Question: Hello,

I have Gerd with most symptoms being LPR, or in the throat. I have a demester score of 38, and a lax sphincter and suffer daily with pain in my throat and tongue. I really don't want to have a nissen, but what are the chances this may help me? Is it a dangerous surgery to have concerning side effects? What would you do?

Thanks, XXXXXXX
doctor
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
As detailed below.

Detailed Answer:
Hi.

Thanks for your query.

Noted the history and understood the concerns.

To recapitulate: Female/40 GERD - LPR - deMeester score of 38 - >14.72 - lasx sphincter - daily pain in throat and tongue - does not want Nissen Fundoplication - wants to know how much it would help you - dangers - sides effects and what would I do.

My thoughts:
Would like to know the management done till now - medications, change in lifestyle, diet, control of stress and anxiety and so on on your side and from your Doctors.

First of all a very good medical management be tried and I would suggest you the following:
PPI as must have been advised by your Doctors
Trial with Domperidone or Metoclopramide at 8 hourly interval.
Antacids particularly when on empty stomach.
Soft bland diet; small frequent feeds.
Avoidance of all foods, beverages and other factors that are known to instigate or enhance the symptoms.
Control of stress and anxiety has a large role to play.
Sleeping in a propped up position.
Control of overweight or obesity if you have.
Avoiding all those actions that increase intra-abdominal pressure.
Control of coughing, constipation and all such factors.
Review scores after a stipulated time, review of symptoms improvement.

Surgical management only if the total medical management fails.
Nissen fundoplication done in the hands of well experienced Surgeon is known to give great result even in long-term provided the medical factors are also well controlled.
It is needed only if the medical management fails.
It is not a dangerous surgery. The complications can be immediate post-op bleeding, perforation of the esophagus or in a long-term in the form of bloating and dumping, failure and so on.

I hope this answer helps you.

Regards.

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. T Chandrakant 1 hour later
I have a few more questions.

I was on donparadom with Tecta and sucrolafate for 3months last year with no relief of sore throat sore soft palate and burning tongue. Motility issues developed within last 6 months and severe burning in esophagus that can be relieved with Zantac and Gavascon. I'm not over weight and was on the acid watcher diet for 3 months.

1. IF PPI's aren't providing relief from my throat symptoms, will surgery provide relief?

2. Do you know of the best surgeries in the upper states or Toronto, Canada?

3. And have you heard of a hill repair, and is it required before a partial wrap to prevent another hernia?

4. And would you do this surgery knowing all the potential complications?

5. And lastly!!! Is a partial wrap good enough since I have motility issues.

Thank you SO Much

doctor
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
As detailed below.

Detailed Answer:

Hi,

Thanks for your feedback.

Since Zantac and Gaviscon did relieve your symptoms of severe burning in esophagus due to motility issues 6 months ago, these should have helped for the sore throat, sore soft palate and burning tongue too.

It would hence be better to take an opinion of an ENT Surgeon too to be sure about whether symptoms are related to reflux problems or other things.

To answer your specific questions:
1. IF PPI's aren't providing relief from my throat symptoms, will surgery provide relief?
> It is necessary to get an opinion of an ENT Surgeon to rule out local problems as discussed above. If the symptoms are related to reflux, surgery would then may help to relieve symptoms.

2. Do you know of the best surgeries in the upper states or Toronto, Canada?
> I do not really know. Will contact the office to assist you in this regards.

3. And have you heard of a hill repair, and is it required before a partial wrap to prevent another hernia?
> I do not think that Hill Repair is that frequently done, Nissen is. I am not really much aware of Hill Repair.

4. And would you do this surgery knowing all the potential complications?
> Surgery needs to be done if all the medical management fails to help you. I would still give more time for detailed medical management.

5. And lastly!!! Is a partial wrap good enough since I have mobility issues?
> Nissen is a standard procedure. If needed better to go for Nissen. But it is ultimately the preference, experience and practices that your operating Surgeon follows decides the procedure, follow-up and sequel.

I hope this answer helps you further.

A note: Acid watcher diet has to be decided by your past experience about the foods and beverages that instigated or enhanced the problems.

Regards,
Dr. T Chandrakant, General Surgeon


Above answer was peer-reviewed by : Dr. Nagamani Ng
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