Luke from Dallas sent us this question:
I am a 65-year-old man with revision of a Nissen fundoplication in 2018.
5’11 185 lbs.
Symptoms did not improve (even temporarily) following either procedure.
Barium swallow two days ago:
1. Moderate size paraesophageal hernia containing the proximal stomach.
2. Changes suggestive of prior gastric fundoplication with disrupted
wrap.
Since I have no significant weight problem is gastric bypass still the best option?
Dear Luke,
Properly performed Nissen fundoplication and hiatal hernia repair is the most reliable and effective treatment for acid reflux disease. Nissen fundoplication is safer, less invasive and more suitable for an acid reflux patient with normal BMI than gastric bypass surgery.
To answer your questions, one need to know whether your initial and redo Nissen fundoplication and hiatal hernia repairs were performed by expert acid reflux specialists. I have noticed that the esophagus is incompletely mobilized in most revisions I perform at Houston Heartburn and Reflux center for recurrent paraesophageal hernias. Incomplete esophageal mobilization is a common mistake in acid reflux surgery that leads to hiatal hernia recurrence, slipped Nissen fundoplication and poor acid reflux symptom control. If this is your case, third time revision is indicated and is typically associated with good outcome.
In rare cases of short esophagus, a gastric bypass may be indicated in lieu of an esophageal lengthening procedure and Nissen fundoplication also called Collis gastroplasty.
Of note, gastric bypass while effective at controlling acid reflux, does not restore the anti-reflux barrier like a Nissen fundoplication. Gastric bypass simply diverts gastric acid away from distal esophagus.
To summarize, we strive at Houston Heartburn and Reflux center to offer a properly performed Nissen fundoplication and hiatal hernia repair for the right patient from the get-go. Consequently, our revision rate for Nissen fundoplication and hiatal hernia repair that we perform is almost zero. It is crucial to choose an expert acid reflux surgeon to perform your Nissen fundoplication and hiatal hernia repair. Once again, a properly performed Nissen fundoplication and hiatal hernia repair is the best solution for acid reflux disease.
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