Nissen or Nissen-Rossetti Fundoplication for reflux/GERD relief?

Gwen M.
on 3/3/18 7:00 pm, edited 3/3/18 7:02 pm
VSG on 03/13/14

Disclaimer: I don't have GERD/acid issues, I'm just paranoid.

I know that RNY is the go-to for "fixing" GERD after VSG, but have you had, or do you know of anyone, who has had Nissen or Nissen-Rossetti Fundoplication to resolve GERD instead?

Research (from pubmed.gov) seems to support this as a viable option, but I don't think I've seen anyone mention it on OH.

(Search does turn up posts about it over the years. Looking for more recent feedback.)

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 41 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

hollykim
on 3/3/18 7:02 pm - Nashville, TN
Revision on 03/18/15
On March 4, 2018 at 3:00 AM Pacific Time, Gwen M. wrote:

Disclaimer: I don't have GERD/acid issues, I'm just paranoid.

I know that RNY is the go-to for "fixing" GERD after VSG, but have you had, or do you know of anyone, who has had Nissen or Nissen-Rossetti Fundoplication to resolve GERD instead?

Research (from pubmed.gov) seems to support this as a viable option, but I don't think I've seen anyone mention it on OH.

the Nissan is not possible after rny or the sleevecsuse the procedure uses a large part of a full size stomCh to wrap around the esophagus.

There is not enough stomach to use after a rny or sleeve.

 


          

 

Gwen M.
on 3/3/18 7:08 pm, edited 3/3/18 11:18 am
VSG on 03/13/14

Hm. I wonder if this is true for all types of fundoplication, as the partial varieties would require less stomach to wrap.

It seems like the best option is fundoplication at the same time as VSG. I wonder if this is something that will become more common in the future as a preventative measure?

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 41 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

hollykim
on 3/4/18 10:06 am - Nashville, TN
Revision on 03/18/15
On March 4, 2018 at 3:08 AM Pacific Time, Gwen M. wrote:

Hm. I wonder if this is true for all types of fundoplication, as the partial varieties would require less stomach to wrap.

It seems like the best option is fundoplication at the same time as VSG. I wonder if this is something that will become more common in the future as a preventative measure?

my general surgeon told me that fundoplication was not a possibility st all after these weight loss surgeries.

Dont know about it changing in the future.

 


          

 

stacyrg
on 3/5/18 10:33 am
VSG on 05/12/14

My surgeon agrees. He says that after a VSG, a fundoplication is not possible if the sleeve is constructed correctly. There simply is not enough fundus. We actually had this argument with my insurance company prior to my revision. Aetna would have preferred that I have a Nissen to address my post surgery acid, but it simply wasn't possible.

My SIL-to-be had a Nissen to correct her acid, then had my surgeon repair it when her initial fix loosened up. It's a great fix for a non-sleeved stomach.

As far as it being a good fix for GERD at the time of a sleeve, I'd be skeptical. One of the causes of post-surgery GERD is the high pressure, closed system that a VSG creates. A fundoplication wouldn't change that. My understanding is that it helps if you have a less than optimal lower esophageal sphincter, since wrapping the fundus around the esophagus helps to tighten the LES. If your GERD is not primarily caused by a lax LES, I don't know that fundoplication/VSG would be the best option. I am a true believer that if you have reflux/GERD prior to VSG, your best bet is RNY

Donna L.
on 3/5/18 5:10 pm - Chicago, IL
Revision on 02/19/18

One of the big reasons they suggest RNY, is that you have a nearly 100% shot to resolve it with RNY This is because post-RNY you basically have no parietal cells connected to the esophagus. These are the cells that make acid with the stomach. With any fundoplication, the possibility for reoperation is always there, as the statistics for failure tend to be 10-20% depending.

Part of the issue too I'd imagine is that every surgery creates adhesions. Every time the stomach is manipulated creates more of these on its own because the stomach has to be dissected out of where it is to manipulate. It minimizes trauma to the stomach to operate once instead of several possible times.

I had actually studied some of the new variants out there, but in general they are experimental at best, and there's not much data I considered weighty enough to sway my decision. In my case though, the GERD was both high pressure and acid overproduction, so a fundoplication would only delay the inevitable.

One assumption on my part is that it'd also be easier to get hiatal hernias post-op with a sleeve, given the narrow tube-like nature and the hole in the diaphragm, so I'd assume they'd want to rule that out since it's an easier fix. I've never read a study regarding GERD in DS and VSG peeps that determined the cause per se, though. That would be interesting to evaluate.

I follow a ketogenic diet post-op. I also have a diagnosis of binge eating disorder. Feel free to ask me about either!

It is not that we have so little time but that we lose so much...the life we receive is not short but we make it so; we are not ill provided but use what we have wastefully. -- Seneca, On the Shortness of Life

Anthonycat
on 3/6/18 6:58 am
RNY on 05/01/18

I'm having the Bypass instead of Nillsons for 2.6 years of Silent Gerd. Surgeon thinks better chance of success. I've told her I don't want to be thin and still coughing until I vomit after every meal. She assured me that won't happen. Just sorry no relief for three months due to insurance hoops.

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