This expert forum is not accepting new questions. Please post your question in one of our medical support communities. Excessive gas months after fundoplication surgery Judynow.
I had laparscopic fundoplication surgery in I was in the hospital 10 days, liquids for 2 weeks, mushy diet for another 4 weeks and now eat small meals.
A few months after this surgery I started having extreme amounts of flatulence. My doctor told me people with GERD swallow air and nothing can be done about it. However, I've had GERD for 30 years with no problems of flatulence, not after the 1st fundoplication, and not currently until about months following the latest operation. I am able to burp, but do so only in small amounts and not very often.
He said the gas would get better when the surgery loosened, but that would take years. Before the surgery which undid and redid the previous surgery he said the laparoscopy was not a good way to do the operation; he said open surgery was the best way and would last the rest of my life I'm 62, my parents are 90; looking at 30 years?
If this surgery will also loosen, besides my major concern about the flatulence, I'm concerned the pre-surgery problems will return again. Mornings are fairly clear of the problem with the gas worsening as the day goes on. At bedtime it is very severe. I am told it goes on through the night, and upon awakening it is still a problem.
I have tried not eating afterand ingesting only liquids after I chew my food very carefully and thoroughly, eat small meals and am very careful what I eat. With my evening meal I take Beano before eating and Gas-X after eating. I take 3 Gas-X at bedtime.
Sometimes this helps, sometimes it does not. In an effort not to overdose on them, and since early in the day the gas is less, I usually do not take them with breakfast or lunch.
These pills sometimes seem to help, sometimes not. This is a huge problem. Please tell me there is a solution to this extremely significant problem. Thank you. Read 4 Responses. Follow - 1. Kevin Pho, MD. I cannot comment on the surgical issues, but there are further tests that can be considered for the gas. An upper endoscopy can exclude inflammation or anatomical abnormalities that may lead to the feeling of increased bloating or gas. Breath tests can be obtained to exclude bacterial overgrowth or lactose intolerance.
I would also consider stool tests to evaluate for malabsorption as well as celiac disease. If the tests remain negative, irritable bowel syndrome can be considered - as this can lead to the feeling of increased bloating.Fundoplication is one of the most common surgeries used to treat heartburn caused by gastroesophageal reflux disorder GERD.
GERD is a chronic backup of stomach acid or contents into your esophagusthe tube that food goes down when you eat. GERD can weaken the muscles that help move food down into your stomachincluding the sphincter that closes the opening between the esophagus and stomach. Fundoplication helps strengthen this opening to prevent food and acid from going back up.
This procedure is usually successful and has a good long-term outlook. Fundoplication is a last-resort surgery for GERD or a hiatal herniawhich happens when your stomach pushes up through your diaphragm. For example, if you have mild gastroparesisa condition in which your stomach empties slowly, fundoplication will probably help. Each procedure can be done laparoscopically. This means that your surgeon makes several small incisions and inserts tiny surgical instruments and a small, thin tube with a camera and light to perform the surgery.
Then, your doctor will put intravenous IV tubes into your veins for both fluid regulation and anesthesia during the surgery. Each type of fundoplication has slightly different steps. But each takes about two to four hours and follow a similar overall procedure. You may need to make changes to your diet to prevent any long-term discomfort or complications after this procedure.
Fundoplication is a highly effective surgery for treating GERD, reflux-related symptoms, and hiatal hernias. Talk to your doctor about which type of fundoplication will work best for you. Some techniques have a higher chance of complications or may require follow-up surgery:. Acid reflux or GERD can lead to some unpleasant symptoms, like heartburn, a sour taste in the mouth, and even difficulty swallowing.
GERD symptoms, such as coughing, nausea, and hoarseness, are affected by what you eat. What causes your acid reflux can be very individual and hard to pin down. Learn how to drink alcohol without getting that familiar burning feeling.
It can also be one of the common symptoms of acid reflux.
Postoperative Gastrointestinal Complaints After Laparoscopic Nissen Fundoplication
Generally, you can tell the…. Gastroesophageal reflux disease GERD is a chronic condition that can make it difficult to sleep well. Learn some tips to help you sleep better. Nissen fundoplication is a surgical approach for treating GERD. This surgery corrects the weakened area of the esophagus that allows acid to flow…. Read more about this procedure and how GERD is now being treated.Is this normal and is gastroparesis common or rare. Surgery was a redo of same surgery 25 yes ago.
I tell all my Nissen fundoplication patients at Houston Heartburn and Reflux Center that they should have almost no pain 2 to 3 days after surgery. Laparoscopic Nissen fundoplication is a minimally invasive procedure performed through tiny incisions.
Gastric necrosis: A late complication of nissen fundoplication
Consequently, recovery is fast, and it is associated with very little discomfort. Epigastric pain 8 weeks after laparoscopic Nissen fundoplication, primary or revision, is not common.
Burping after Nissen fundoplication is not common either. Patients may have small burps results from small amount of air trapped above the wrap. Gastroparesis is not common at all following Nissen fundoplication performed by expert hands. The risk of injuring the vagus nerves may be higher in revision surgery. I typically order a baseline gastric emptying study prior to revision Nissen fundoplication surgery to make sure there is no vagal nerve injury to start with.
Gastroparesis symptoms include postprandial epigastric pain pain after eatingbloating, nausea and vomiting. At Houston Heartburn and Reflux Center, we ask our Nissen fundoplication patients to report back to us for any question or concern after surgery. Thorough evaluation, good physical exam and comprehensive symptom evaluation can help guide additional treatment if needed. Elias Darido.Gastric necrosis is a rare condition because of the rich blood supply and the extensive submucosal vascular network of the stomach.
It may cause severe gastric dilatation, but very rarely an ischemic compromise of the organ. Other factors, such as gastric outlet obstruction, may concur to cause an intraluminal pressure enough to blockade venous return and ultimately arterial blood supply and oxygen deliver, leading to ischaemia.
We report a case of a year-old women, who presented a total gastric necrosis following laparoscopic Nissen fundoplication and a pyloric phytobezoar which was the trigger event. No preexisting gastric motility disorders were present by the time of surgery, as demonstrated in the preoperative barium swallow, thus a poor mastication patient needed no dentures of a high fiber meal cabbage may have been predisposing factors for the development of a bezoar in an otherwise healthy women at the onset of old age.
A total gastrectomy with esophagojejunostomy was performed and patient was discharged home after a 7-d hospital stay with no immediate complications. We also discuss some technical aspects of the procedure that might be important to reduce the incidence of this complication.
Core tip: Gastric necrosis is a rare condition because of the rich blood supply and the extensive submucosal vascular network of the stomach. We report a case of a year-old women, who presented a total gastric necrosis following laparoscopic Nissen fundoplication and we discuss technical aspects of the procedure that are important to prevent this complication.
The rich blood supply of the stomach preserves this viscera from ischemic events, even after the ligation of all the major vessels[ 1 ] a. Notwithstanding this fact, acute gastric dilatation accompanied with or without gastric outlet obstruction[ 2 - 7 ], eating disorders[ 8 - 10 ] or gas-bloat syndrome are recognized causes of ischemic gastric necrosis.
The gas-bloat syndrome is defined as a variable group of symptoms resulting from the inability to relieve gas from the stomach after fundoplication. Gastrointestinal gas may proceed either from an excessive production carbohydrate or fat rich food, small intestinal bacterial overgrowth or from an excess of swallowed air disphagia secondary to orophagryngeal or esophageal motility disorders or anxiety disorders with inefficient chewing, gastroesophageal reflux disease, etc.
The predominant complaint is bloating, but other symptoms include abdominal distention, early satiety, nausea, upper abdominal pain, flatulence, inability to belch, and inability to vomit[ 11 ]. Antireflux surgery may contribute to the obstruction of gas blow into the esophagus by means of different mechanisms[ 12 ] surgically altered physiology of the gastroesophageal junction, surgical injury to the vagus nerve, mechanic compression of the wrapspecially when associated to previous gastroesophageal motility disorders, such as delayed gastric emptying.
Delayed gastric emptying is a preexisting condition in many of the patients undergoing antireflux surgery. Nevertheless, a thoughtful preoperative assessment of esophagogastric motility with barium swallow is mandatory and may identify a subset of patients that will still have symptoms related to motility disorders postoperative. Very few cases of near-total or total gastric necrosis following Nissen fundoplication have been reported.
We present a case of gastric necrosis following laparoscopic Nissen fundoplication and pyloric obstruction by a phytobezoar. A year-old women was admitted to our Emergency Room with a history of sudden abdominal pain, without nausea or vomiting.
No other symptoms were reported. The surgical record described a Rossetti-Nissen fundoplication without diversion of short gastric vessels SGVwith a short wrap 3 cm and suturing of the valve to the right crura. Treatment history revealed no medication that could interfere with upper digestive tract motility. On physical examination, she was conscious, alert and oriented.
The abdomen was distended, painful to palpation with generalized peritonism and involuntary guarding in the epigastrium. Bowel sounds were diminished. Laboratory findings revealed: hemoglobin, Arterial blood gases showed a metabolic acidosis with a blood pH of 7. In the operating room an extreme gastric dilatation was found with ischemic changes. The lesser sac was opened and dissection of the posterior gastric surface confirmed endoscopic findings. An anterior longitudinal gastrotomy was performed and trapped air was released.These symptoms typically are treated medically without an extensive evaluation to identify the cause.
We reviewed our experience of laparoscopic Nissen fundoplication to determine the course of postoperative symptomatology in our patient population, and present a rational approach to this problem. Over a year period, patients underwent primary laparoscopic Nissen fundoplication for gastroesophageal reflux disease; patients were evaluated with a standard set of questions for postoperative gastrointestinal complaints.
Three- and 6-month follow-up data were compared by using the chi square test. All of these patients had symptoms during the first 3 postoperative months. Patients with persistent reflux or dysphagia after 3 months typically had an anatomic failure of the operation. Most patients who have undergone laparoscopic Nissen fundoplication for gastroesophageal re-flux disease will have gastrointestinal complaints during the initial 3 postoperative months.
Nearly all of these patients will have resolved their symptomatology after 3 months. Those with persistent symptoms after 3 months warrant evaluation for operative failure.
A popular option for the surgical management of gastroesophageal reflux disease is minimally invasive Nissen fundoplication. The floppy Nissen fundoplication is favored for the treatment of gastroesophageal re-flux disease because this procedure maximizes reflux control while minimizing dysphagia. Minimally invasive Nissen fundoplication was first described in One observation we have made in our own series of minimally invasive Nissen procedures is the routine occurrence of temporary postoperative gastrointestinal complaints this observation also has been made by others 8 — We also have observed that many patients are treated by their referring physicians for these temporary postoperative gastrointestinal symptoms, perhaps too aggressively, as noted by others.
We found that the vast majority of postoperative gastrointestinal complaints after minimally invasive Nissen fundoplication are temporary, and do not require prolonged if any medical treatment. Over a year period, patients underwent laparoscopic Nissen fundoplication under the supervision of the first author CTF.
The typical indication for fundoplication in this series was gastroesophageal reflux disease; this diagnosis required objective evidence that usually was in the form of esophagitis on endoscopy or a positive ambulatory pH study, or both. In addition, we used prosthetic reinforcement of the cruroplasty when faced with a large hiatal defect; this practice reduced hiatal hernia recurrence in a randomized trial.
Postoperative follow-up was performed in the office of the supervising surgeon at 1 week, then at 1, 3, and 6 months, and then yearly. Postfundoplication dietary restrictions included avoidance of carbonated beverages and gas-producing food for 3 months, and eliminating meat for 1 month after surgery. In general, the patients had no dietary restrictions after 3 months. Questions Administered at Each Follow-up Visit Do you have difficulty swallowing?
If so, does the difficulty seem to be in the upper or lower chest? Is the difficulty with solids or liquids or both? Recurrent reflux ie, a failed procedure occurred in 16 patients 2. The vast majority of these symptoms were resolved within the first 4 weeks to 6 weeks after the procedure data on the precise time of symptom resolution are not available.
Of note, 5 patients with persistent flatulence or diarrhea carried a preoperative diagnosis of irritable bowel syndrome. Eleven patients with bloating and flatulence and 4 patients with diarrhea were evaluated with upper endoscopy, colonoscopy, and Clostridium difficile testing; none of this evaluation identified causative pathology. Other authors also have observed similar rates of temporary complaints after an antireflux procedure.
Postoperative symptoms like bloating, flatulence, and dysphagia can be minimized with the avoidance of carbonated beverages, gas-producing foods eg, beansand coarse substances eg, red meat. Patients may still have the sensation of heartburn after a successful antireflux procedure. This is not necessarily indicative of recurrent reflux, but possibly due to irritation of the esophageal mucosa secondary to drinking a relatively caustic beverage, such as citrus juice or alcohol.
These beverages also should be avoided for several months so that the patient's esophagitis has a chance to resolve. If gastrointestinal symptoms occur during the first 3 months after fundoplication, our evidence suggests that the symptoms resolve in the vast majority of patients.
Chronic medication is not required. The only treatment needed at this point is patient education and reassurance. If a patient has symptoms that persist beyond the 3 months postoperatively, however, an endoscopic and contrast fluoroscopic evaluation should be undertaken.
The cause of postoperative dysphagia is multifactorial, 10 including factors such as an undiagnosed motility disorder eg, achalasiaa wrap failure eg, slippage, overly tight wrap or cruroplasty, or corpus wrapretroperitoneal hematoma, or peptic stricture.Reviews continue to play a key role in establishing the public reputation of a local business, directly influencing how consumers feel about a business.
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