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Ask Internist Your Own Question
Internist, Board Certified Physician
Category: Medical
Satisfied Customers: 4766
Experience:  Int. Med., Gastroenterology. Fellow American College of Physicians. Trained, located in the U.S.
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Failed hiatal hernia repair with failed Nissen

Customer Question

Failed hiatal hernia repair with failed Nissen fundoplication repair post 3 years. Symptoms increasing. Positive reflux with 24 hour pH testing. Acid controlled with 80 mg Omeprazole/day. Positive Barrett's esophagus. Frequent diaphragmatic contractions. Stomach dumping syndrome with food passing through stomach at higher rate than typical. Globus in a.m. Abnormal stools that are thin pencil-like or pellets. Color may be yellow. Low IgA at around 20 mg. EGD on 1/19/2011 showed hiatal hernia. Any recommendations for procedures other than fundoplication, surgeons, hospitals. Not in a good city for surgical re-do. Current Gastroenterologist recommends seeing a surgeon, but I am not happy with hospitals in city where I live and surgeons are limited. I am an occupational therapist and see patients with failed surgeries on a regular basis. I know that the surgeon is not always to blame, but I cannot consider surgery in this city. Thank you for any recommendations.
Submitted: 6 years ago.
Category: Medical
Expert:  Internist replied 6 years ago.
I am confused about your statement that the symptoms are increasing but the acid is controlled. Please explain more fully.
Customer: replied 6 years ago.
My gastroenteroloist reported that I continue to have reflux without acid because I am taking proton pump inhibitors at a high concentration. My stools are abnormal, though. I have pencil like stools that are yellow that I read is related to GERD. I also have pellet like stools. I have more bloating than typical, I have a difficult time knowing what foods to eat that will not cause GI symptoms. My EGD performed on 1/19/2011 shows a hiatal hernia. My LES valve is ineffective so this is most likely the reason for the reflux. My diaphragm muscle contracts frequently. My gastroenterologist feels that I need a surgeon consult and possibly another surgery because of the above mentioned symptoms. I never feel good but I work every day. I do not know the results of the small intestine biopsies to test for Celiac's disease. Who knows why an IgA would be so low except 1 in 400 caucausians have this immune condition. I have globus every day that I know is supposed to be related to anxiety. Going through another surgery with the Nissen fundoplication procedure is not desired and I just wondered if there are other options. I am not obese, my job requires exercise -----------
Expert:  Internist replied 6 years ago.
It appears from your description you Not although your are having reflux you do not Have severe symptoms of GERD and reflux. In my experience GERD would not cause the complaints that you have about your stools. The bloating and pellet-like stools are more consistent with irritable bowel syndrome. Your symptoms also are not typical of the celiac disease. what you will need to do to have normal stools and less loading is to put more bulk and fiber in your bowel movements. This can be done with increasing the fiber and roughage in the diet with salads bran. You must be careful of vegetables which cause gas and bloating such as broccoli for example. Also you need to try a fiber supplement such as Metamucil or Citrucel to introduce these in small amounts because they can cause bloating. a few did not have severe heartburn and reflux I would suggest you give the above recommendations a trial before contemplating repeat surgery.
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Expert:  Internist replied 6 years ago.
one oth
Customer: replied 6 years ago.
I believe I did reply to your answer but I will reply again. Your answer is incorrect. I thought that I had IBS, but I started taking medication for IBS and this did not stop symptoms except to maybe reduce some inflammation. I also take Turmeric for inflammation and an enzyme supplement. I use Metamucil powder on food every day. I DO have GERD without acid because I take 80 mg of omeprazole every day. My GI physician did a 24 hour study to test for GERD and acidity. With the medication my reflux is not acidic. I also have Barrett's esophaus which indicates that I have had GERD. My recent EGD showed a hiatal hernia and that my fundoplication has reversed and not effective. I do need to repeat the surgery. I was hoping that you could recommend a hospital or a surgeon for a repair. My city has poor hospitals and few surgeons and I will not have repeat surgery in my city.
Expert:  Internist replied 6 years ago.
You never said where you live. How could i recommend a surgeon or hospital. You question was unclear. You should accept for the answer I gave you and the time spent.
Customer: replied 6 years ago.
I willl not accept a wrong answer. Maybe this is a lesson to you. It does not matter in what city I live. I can have any kind of repair in any city. If you had to do so much research and spend so much time, maybe you should review your medical practice.
Expert:  Internist replied 6 years ago.
Customer: replied 6 years ago.

I am open to going to any city in the USA for surgery, does not matter that I live in Albuquerque. I belive the majority of my current symptions are due to a non-functioning LES and the hiatal hernia. I had a Nissen fundoplication performed about 3 years ago.

Was symtom free for 2 years after. Now LES is again not functioning and now have hiatal hernia. I understand redo's on Nissen fundoplication are tricky. I'm am seeking a facility and Surgon that has had experience and high success with redo's, do you have any suggestions?

Also, are there now alternatives to Nissen fundoplication that are effective? I have read about a method using an implanted ring to serve as an LES. Can not find any info about effectivmess or where it is performed.

Yes, I could also have IBS, I want to solve one issue at a time. I believe if I have IBS it is secondary to my most severe symtoms.

Sorry for getting on you, I just don't feel good.