Fundoplication post esophagectomy

Jameyfritz

I know reflux is a big issue with post-Esophagectomy patients. Does anyone know if fundoplication has ever been done post Esophagectomy to help control this. I've noted that in Australia they have done it at the time of Esophagectomy when completing the anastomoses with mixed results. Thanks. Have been trying to get used to the new"normal" with mixed success. 16 weeks post surgery. Thanks for any feedback. Jim in Hawai

LorettaMarshall

Jim~Post-op EC patient diet adjustment can take 4 mos. R more!

Well welcome Jim

Always wanted to go to Hawaii—closest I got to that was when I paid the way for one of my grandsons to go with his Senior class.  That is now only a “dream vacation” for us, meaning “only in our dreams.”  After a certain time, things change, and plans put off too long often fail to become a reality. 

First, let me congratulate you on having a successful Esophagectomy.

Secondly, did you know that only 4 months out from surgery, many post-Esophagectomy patients are still wrestling with reflux problems?  The most I can do that might be helpful is to give you a reference from the University of Pittsburgh Medical center concerning your diet after an Esophagectomy.  My husband is now well into his 14^th year of survival after having an Ivor Lewis Minimally Invasive Esophagectomy performed by Dr. James D. Luketich at UPMC. 

My husband still has problems with “acid reflux”, and it is usually brought on by something he ate too much of, or having eaten too late at night and then going to bed—always a “no-no!”  And also the elevated position when he sleeps plays a role as well.  He sleeps on a wedge with a couple of pillows on top of that.  Sometimes he turns over and gets completely off to the side.  Lying flat is never good!  (Some of our friends have invested in an adjustable bed.  That's a good investment.)

William's doctor has prescribed a 40mg. Omeprazole dose that can be taken if the problem persists night after night.  But this isn’t a persistent problem so he rarely takes one. 

Incidentally, we’ve found that “Alka-Seltzer” makes an antacid that we like much better than “Tums”.   The label reads “Extra Strength Heartburn Relief Chews”.  But mind you if he wakes up during the night, as he sometimes does with a real “burning and bitter” reflux, it takes him at least half an hour for him to find “relief.”  There’s no turning over and going right back to sleep when these episodes occur.   But believe me, it’s a small price to pay for the miracle of surviving Esophageal Cancer Stage III (T3N1M0). 

I haven’t read of anyone posting here that has had an Esophagectomy and then later undergone a fundoplication.  And I couldn’t imagine that it would be possible post Esophagectomy.  The reason being, that your stomach and Esophagus have already been “rearranged”!  As you well know, the Esophagectomy involves the removal of all or part of your Esophagus, and the stomach is spliced, elongated and made into a new gastric conduit as a substitute Esophagus.  So seems to me it would be impossible to “wrap the stomach around the Esophagus” after it has already been “spliced and pulled up in such a way to make a substitute Esophagus.” 

Now Jim, I’m not a doctor obviously, but by reading about the procedure as outlined in the reference below my name, seems to me the stomach has already been “used for the purpose of making a new Esophagus, so to speak.  It is called a gastric tube or a gastric conduit.  In my simple way of thinking, since the stomach is already drastically altered, one would think a patient either has a fundoplication or they have an Esophagectomy.  I can see a patient having either one or the other, but not both.   You say that it has been done simultaneously with an Esophagectomy in Australia but with “mixed results.”  However, in my 15 years of observing postings on this site, I cannot recall a time when someone here in the states has written about first having an Esophagectomy and then later having a fundoplication.  Now that is not to say that I’ve read every posting you understand.

As I understand the procedure of fundoplication, the stomach is wrapped around the Esophagus.  In an Esophagectomy, the stomach is made into a new gastric tube to replace all or part of the diseased Esophagus.  That’s my personal layman’s observation. 

Take note of the “youtube video” narrated by Dr. Pennings of how a laparoscopic Nissen Fundoplication is performed.  (Reference 3)

And just in case you haven’t viewed a video of an Ivor Lewis Minimally Invasive Esophagectomy, I’ve also included an excellent segmented 45-min. video by Dr. Ninh Nguyen who served with Dr. James D. Luketich back in the mid-90’s when Dr. Luketich first pioneered the MIE.  (Reference 4)

So Jim, I discussed this with my husband as usual, and we both agree that perhaps you may be a bit over-anxious.  We think 4 months post-surgery is still a time-frame in which you can have more problems with reflux than you will further along in your recovery.  We wish you all the best and we believe that things will “settle down—not up” in due time. 

Loretta (& William) Marshall

(William diagnosed Nov. 2002 - MIE @ UPMC May 17, 2003 by Dr. James D. Luketich - William's last PET scan just conducted in March 2017 shows STILL NO EVIDENCE OF DISEASE (NED) - We thank God for this miracle!

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1. http://www.upmc.com/patients-visitors/education/nutrition/pages/esophagectomy.aspx

“Diet After an Esophagectomy

An esophagectomy (ee-soff-uh-JEK-tuh-mee) is surgery to remove the esophagus. After this type of surgery, it is common to have some problems eating for a few months.

What can I expect after surgery?

For the first few months after surgery, you may have problems such as:

• Weight loss

• Dumping syndrome (nausea, diarrhea, abdominal cramping, light-headedness)

• Excess gas

• Trouble swallowing

  Your diet plan after surgery is designed to lessen your discomfort and allow you to enjoy eating…”

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  2.  http://www.gerdhelp.com/treatment-options/antireflux-surgery/?gclid=CJ7g_b6mltMCFcOKswod680Mbw

  “The most common antireflux surgery is known as a fundoplication (fundo means top of stomach and plication means to fold).  Fundoplication procedures involve wrapping the upper portion of the stomach around the end of the esophagus and stitching it in place

   This technique reinforces the antireflux barrier and the junction between the esophagus and the stomach…

When to Consider Antireflux Surgery

Most people with mild GERD can successfully control symptoms through dietary and lifestyle changes. Sometimes people begin using over the counter and/or prescribed medicines. For patients who experience inadequate relief and/or side effects from medication, surgical intervention may be appropriate.  In addition, surgery may be suitable for patients who have any of the following:

• concerns about the long-term side effects or costs associated with medication

• certain complications of GERD (e.g. Barrett’s esophagus, narrowing of the inside space of the esophagus)

• symptoms of GERD outside the esophagus (e.g. asthma, hoarseness, cough, chest pain, aspiration)…

  The goal of a fundoplication is to restore the normal functions of the junction between the esophagus and the stomach. This is accomplished by wrapping the upper portion of the stomach (the fundus) around the esophagus either partially or totally.  

  The specific goals of the surgery are:

• Reduction of a hiatal hernia (if present) by repairing the enlarged opening of the diaphragm and ensuring that the stomach and esophagus are properly positioned below the diaphragm

• Restoration of the angle at which the esophagus enters the stomach

• Increase in the pressure of the muscle that controls the valve between the stomach and the esophagus; this recreates a one-way valve to prevent reflux…”

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  3.  https://www.youtube.com/watch?v=ThmrNW4pl8E

   Laparoscopic Nissen Fundoplication Surgery

  Northwest Bariatrics - Published on Sep 19, 2014

  Laparoscopic Nissen Fundoplication Surgery Watch Dr. Pennings explain and perform a Nissen Fundoplication Surgery. http://www.surgicalbariatrics.com/

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  4.  https://www.youtube.com/watch?v=hx4hS21AbuI

  “Uploaded on May 4, 2011 - DUE TO THE GRAPHIC NATURE OF THIS VIDEO, VIEWER DISCRETION IS ADVISED.
  
  Minimally Invasive Esophagectomy featuring Ninh T. Nguyen, MD, Professor of Surgery Chief, Division of Gastrointestinal Surgery, University of California, Irvine Medical Center (SDMK13CD0800259)

  Category - Science & Technology - License - Standard YouTube License”

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