Patient Information
Surgeries: Laparoscopic: Fundoplication (Lap Nissen)
From a Patient's Perspective
by Jerry Chiaponne
I never thought it would happen to me.
Hello! My name is Jerry and I am a Registered Nurse. I work in a prominent gastroenterology endoscopy unit in the eastern United States. I would like to share my experience with gastroesophageal reflux disease and the surgical treatment called laproscopic Nissen fundoplication.
My problems started about three years ago at work one day. I was eating a pear I had packed in my lunch. This pear was particularly hard and crunchy. As I was gobbling it down I began to experience chest pain. One of my fellow co-workers noticed a change in my appearance and asked if I felt all right. I stated that I was having chest pain and asked if they would hook me up to a blood pressure cuff to monitor my vital signs. They eagerly obliged and the nurse manager contacted our medical director to let him know what was transpiring with one of her employees. I thought I was seriously ill so I was thankful I was already in a hospital!
The chest pain continued and my colleagues transported me to the emergency room around the corner from our department. The medical staff took blood and put an I.V. in my hand. It was possible I was having a heart attack, so the attending physician for cardiology came to work me up. I was 38 years old with a wonderful wife and a beautiful 2-year-old daughter. We had just moved to the state and bought a house. Weird and horrible thoughts began to fill my head. I was scared.
I was admitted to the hospital cardiac-monitoring unit for the night. The next day I had a cardiac stress test, which I passed with flying colors. I thought my heart would prove healthy since I try to take care of myself. So what was going on? Why the pain? The cardiologist on my case said I did have a healthy heart and I probably experienced an esophageal spasm. He referred me to a gastroenterologist. What a relief.
As time passed and I began to spend many sleepless nights sitting on the couch from 1:00am until 3:00am because I was having terrible heartburn and reflux. I knew from working in a G.I. clinic what these symptoms were and how to take care of it. I knew it would go away.
But my symptoms prevailed for two more years. My wife began to voice her concern and suggested I see one of my doctors for evaluation. I cordially agreed with my wife and made an appointment with Dr. Rig Patel in our clinic. He examined me and scheduled me for upper endoscopy (or EGD as we say in the business). This test would allow him to examine the inside of my esophagus and stomach using an endoscopy. I could not believe this was happening to me.
I opted, as most patients do, to have my EGD without any medicine to make me sleepy and comfortable. I wanted to be awake and have the full experience. I have assisted with many patients who opted for unsedated EGD and they all did very well. Now it was my turn.
My upper endoscopy went very well. I can suggest whole heartedley that EGD can be done without medication to make you sleepy. During the test, Dr. Patel found my problem. He said I had a wide-open lower esophageal sphincter that was causing reflux. He started me on Prilosec and suggested I have further studies called esophageal ph probe and manometry.
The medication cooled off the heartburn but I continued to have bad reflux. It felt as if my stomach was coming out of my mouth whenever I belched. Not a pleasant feeling. I had the additional tests that Dr. Patel ordered. They showed that my acid reflux was passing half way up my esophagus and that there was very little motility in the lower half of my esophagus. This is dangerous because continued acid reflux can lead to a cancerous condition called Barrett's Esophagus. Dr. Patel suggested surgery for my problem. The surgical technique is called laparoscopic Nissen fundoplication. Using a rigid telescope insert through tiny holes punched into the belly, the surgeon can wrap the upper part of the stomach around the lower esophagus. This wrap prevents reflux from occurring.
I discussed my surgery with Dr. Ted Trus. He has done many of these procedures and explained all the risks and benefits. He thought that I was a great candidate for this procedure and felt I would have a positive response.
After deciding to go for the lap Nissen, Dr. Trus discussed the postoperative diet that I would need to follow. It was fairly simple and easy to follow. He recommended I eat sloppy, juicy foods such as Jell-o, pudding and ice cream but stay away from dry bulky foods. I followed Dr. Trus' advice along with that of the dietician and everything they said was right. Immediately post op, I ate Popsicles, ice cream and plenty of fluids. Two days post op, I ate scrambled eggs, ground ham, coffee and grits. That may not sound too terribly appetizing, but it was.
After I was discharged from the hospital, I ate sloppy saucy things in small quantities, but numerous times throughout the day. I consumed soft foods and foods topped with lots of sauce or gravy. I avoided dry foods such as bread because it could ball up and get stuck at the area where the "wrap" was done. For the next three weeks, I slowly added foods to my diet but continued to avoid dry foods and carbonated beverages. (Your ability to burp is hampered slightly.) As of today, I eat everything. I am still careful to eat slowly and chew thoroughly.
My post op recovery has been incredible. My surgery was on February 29, 2000. Today I feel great and have not encountered any signs or symptoms of reflux. I contribute my well being to Drs. Patel and Trus for their clinical prowess and experience. Also, my compliance really made a big difference in how well I have been post op. The importance of compliance cannot be understated. The surgeon did a wonderful thing for me and I did not want to undo his handiwork..
Today I eat and drink whatever I want. I still follow a few important directions. Eating slowly and taking smaller bites gets me through every meal. I become full more quickly because my stomach is smaller due to the surgery,
therefore I eat smaller more frequent meals and snacks. The night before surgery, I took my last dose of Prilosec. It felt terrific to take that last dose and know that I won't have to take that medicine again.
Jerry Chiaponne, RN
Charleston, SC