Myotomy after Fundoplication??

[Guest guest]

Hi Everyone,

I'm new here. I had a Nissen Fundoplication (full wrap) at the end of

January of this year. Since then I have had continued problems with

swallowing. I also have been getting reflux, both from things that

haven't made it out of my esophagus to my stomach yet, and stuff from

my stomach. One of the manometry tests I have had since the surgery

indicates I have achalasia (another one showed I have some disorder,

but not enough to diagnose achalasia). Numerous barium swallows have

showed delayed emptying of the esophagus and tendency to pool the

contents high in the esophagus (I have 24 hour a day symptoms of

regurgitation, reflux in throat/nose/airway/etc.). The reflux symptoms

have completely ruined my quality of life, I am not able to function

properly at all anymore. I am at the end of my rope.

One surgeon has recommeded I get a myotomy, based on the achalasia

diagnosis. Has anyone heard of ever having a myotomy AFTER a

fundoplication? At this point, I am not even considering this option.

I would perhaps consider a take-down of the fundoplication, but not a

myotomy. I have had one small dilation that did not seem to do much at

all.

Thanks for any help,

Terry

[Guest guest]

Terry,

Welcome to the group! I'm so sorry to hear you're having so many

problems! Did the tests show achalasia before they did the

fundoplication? Where do you live and where are you going for

treatment? I'm certainly not the expert of the group, but I would

think they could take down the wrap to do a myotomy. It sounds like

you need to get a better diagnosis, first, though. Since achalasia is

a rare disease, not all doctors and/or medical centers see a lot of

cases of it. If you are not working with doctors that are experienced

with this disease, I would recommend getting your test results and

going to see someone who is. If you tell us where you live, someone

from the group can probably recommend a doctor to see.

I don't have achalasia myself, but my husband has had a

different esophagus motility disorder (called Diffuse Esophageal Spasm

or DES) for over 3 years. On recent tests at the Cleveland Clinic

(highly regarded for their work with achalasia patients), a barium

swallow showed achalasia, even though he had been previously diagnosed

with DES. Since DES can be hard to distinguish from achalasia, they

had to do a high-resolution manometry to confirm the diagnosis. Many

others here have had a hard time getting their achalasia properly

diagnosed, too. That's why I've learned that you need a qualified

motility lab to make the call.

I wish you all the best! You are certainly not alone in your

symptoms! Please keep us posted on how things are going!

in Michigan

>

> Hi Everyone,

>

> I'm new here. I had a Nissen Fundoplication (full wrap) at the end of

> January of this year. Since then I have had continued problems with

> swallowing. I also have been getting reflux, both from things that

> haven't made it out of my esophagus to my stomach yet, and stuff from

> my stomach. One of the manometry tests I have had since the surgery

> indicates I have achalasia (another one showed I have some disorder,

> but not enough to diagnose achalasia). Numerous barium swallows have

> showed delayed emptying of the esophagus and tendency to pool the

> contents high in the esophagus (I have 24 hour a day symptoms of

> regurgitation, reflux in throat/nose/airway/etc.). The reflux symptoms

> have completely ruined my quality of life, I am not able to function

> properly at all anymore. I am at the end of my rope.

>

> One surgeon has recommeded I get a myotomy, based on the achalasia

> diagnosis. Has anyone heard of ever having a myotomy AFTER a

> fundoplication? At this point, I am not even considering this option.

> I would perhaps consider a take-down of the fundoplication, but not a

> myotomy. I have had one small dilation that did not seem to do much at

> all.

>

> Thanks for any help,

> Terry

>

[Guest guest]

Hi ,

Thank you so much for the welcome. I really need some friendliness

and hope right now. The tests before the fundo did not indicate

achalasia at all. The manometry was essentially normal (I think

there was some slight oddness, but nothing to indicate any specific

disorder or anything strong enough to rule out surgery). I live in

the San Francisco Bay Area (I think quite a few people on this board

are from around here? My most recent tests were done at UCSF. The

manometry indicated achalasia, but the swallow just indicated delayed

emptying of the esophagus and some spontaneous reflux. I had another

manometry about a month or so earlier at CPMC (California Pacific

Medical Center) after an EGD (so the wires were in my mouth, not up

my nose), and those indicated a major motor disorder with some non-

persistaltic contractions, but did not mention achalasia. One

difference between the manometries was that the UCSF one was done

with me lying horizontal on my right side. The CPMC one was done

with me on my back, with my upper body propped up. I felt this

positioning made a difference in my ability to swallow. I don't

know if anyone else has noticed that with any of their tests

(manometry and/or swallows). I also felt ill for part of the UCSF

one because when the probe was in part of my wrap, it made me sort of

dry heave. I'm sort of at a loss where to go to now for more

testing, any suggestions? I am consulting a surgeon at Stanford, but

am unsure their testing facitilies are any better than UCSF's.

Terry

> >

> > Hi Everyone,

> >

> > I'm new here. I had a Nissen Fundoplication (full wrap) at the

end of

> > January of this year. Since then I have had continued problems

with

> > swallowing. I also have been getting reflux, both from things

that

> > haven't made it out of my esophagus to my stomach yet, and stuff

from

> > my stomach. One of the manometry tests I have had since the

surgery

> > indicates I have achalasia (another one showed I have some

disorder,

> > but not enough to diagnose achalasia). Numerous barium swallows

have

> > showed delayed emptying of the esophagus and tendency to pool the

> > contents high in the esophagus (I have 24 hour a day symptoms of

> > regurgitation, reflux in throat/nose/airway/etc.). The reflux

symptoms

> > have completely ruined my quality of life, I am not able to

function

> > properly at all anymore. I am at the end of my rope.

> >

> > One surgeon has recommeded I get a myotomy, based on the

achalasia

> > diagnosis. Has anyone heard of ever having a myotomy AFTER a

> > fundoplication? At this point, I am not even considering this

option.

> > I would perhaps consider a take-down of the fundoplication, but

not a

> > myotomy. I have had one small dilation that did not seem to do

much at

> > all.

> >

> > Thanks for any help,

> > Terry

> >

>