[tri-med] Re: Nissen Fudoplication undone?

----- Original Message ----- 
From: "Sarah Baptista"
>>  Anyway, my question is, have any of your children ever had their nissens 
>> come undone and if so, what did you do?  I remember the surgeon saying 
>> that it might happen and he seemed to indicate that he would not want to 
>> redo it.

Hi Sarah,
A fundoplication is only temporary, they all come undone eventually. On 
average they last a few months, sometimes a couple of years. Alex's lasted 
quite a long while but thats the exception not the rule. The idea of the 
fundo is to buy a little time until the reason for the reflux resolves, eg 
tone improves, their swallow improves etc etc. Its not considered a 
permenanet solution.

Sometimes they will redo them, sometimes they wont. It depends on the reason 
for the fundo. The general rule is not to redo the fundo unless its 
indicated though.

Some doctors take a wait and see approach, others will do testing to see if 
things have improved (eg pH probes, barium swallows, milk scans etc)

If its because of reflux and esophageal damage they will often try meds 
before redoing the fundoplication. If it was because of aspiration, 
sometimes they will wait until they actually develop aspiration pneumonia 
before considering redoing it.

If it was done simply as a precaution because she was getting a feeding tube 
they probably wont even consider redoing it.

It all really depends on why she had it in the first place, and your doctors 
attitudes.

Alex's fundo is defiitely undone (he undid it "himself" by forcing himself 
to belch as little boys do) and we have been fine with that for a few years. 
Unfortunately his swallow is deteriorating again and the vomiting, nausea 
and heartburn are getting pretty bad. Not sure if they will even suggest a 
fundo again though given that he has a pacemaker (they really HATE operating 
on the area around the pacemaker because of infection risks), his age and 
overall improvement. In our case we will probably have to wait and see what 
develops.

Life consists not in holding good cards but in playing those you hold well.
                                            -- Josh Billings

Keep Looking For Rainbows!!
   _--_|\
 /Karen \
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          v Karen, Mum to Alex (12 years, T-18 Mosaic)
http://members.optushome.com.au/karens

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