Gastric reflux surgery (Nissen fundoplication)
Mr Richard Lehman who lives in Billericay, Essex, came to Spire Hartswood Hospital in February of 2007 after years of suffering from gastric reflux.
Richard was so happy with the treatment he received from us and his consultant surgeon, Mr Dip Mukherjee, that he felt compelled to write about his experience.
Here is his story in his own words.
Richard's Story
My life changed, and very much for the better, when Mr Dip Mukherjee carried out Nissen fundoplication surgery to treat my gastric reflux at the Hartswood Hospital in Brentwood, Essex on the 19 February 2007.
Before surgery
To put it in context I had been suffering from extreme gastric reflux for over 25 years. In fact by the late 1980’s, in my mid 30’s, I had seen a consultant because I was in such pain (though relatively infrequently then) that it was thought that I might have an ulcer. In fact it was ascertained that I had a hiatus hernia and severe reflux. I was advised that whilst surgery was a possibility it was not recommended as it was then considered to be a major operation (given that it was not a life-threatening problem) and that the success rate was not high.
It was suggested that I put up with the pain for as long as possible and hope that, in due course, procedures would improve to such an extent that keyhole surgery might, one day, be a possibility.
My doctor continued to prescribe the normal drugs, together with copious and increasing amounts of Gaviscon!
Over the next two decades the pain got progressively worse and the quality of my daily life deteriorated. By 2006 I was vomiting most nights – certainly two in every three. Indeed I could never go out to dinner with friends without disappearing to be sick at least once during the evening. Eating late (after 7.30pm) and eating spicy foods exacerbated the problem but eating virtually anything would still cause it. During the night I would suddenly sit bolt upright in bed and have to literally run for the toilet as the burning reflux acid entered my throat and mouth. It tasted foul and the pain was intense. During an ‘attack’ my long suffering wife would patiently feed me cold yoghurt on a tea spoon which was the only thing that seemed to assist. Even sipping that was difficult as I fought for breath and relief from the incredible pain. I’ve never actually eaten a bar of soap but acid reflux was the taste that I imagined soap would have but worse!
At times, although I knew perfectly well that I wasn’t, I still wondered if I was having a heart attack as the chest pain was so bad. Following an ‘attack’ (which would usually last between one and two hours before the pain receded) it would leave me feeling as if I had flu. I felt tired, shaky, ached all over and was frequently left with an irritating cough. Going to work in the City the next day was often exhausting.
I purchased an expensive electric bed to raise my head so that the reflux would lessen and was, to all intents and purposes, sleeping in a sitting position most nights. It didn’t really help and I noticed that I got reflux even when I was awake and walking or standing upright. Indeed I could never do such simple things as lay on the floor playing with my grandchildren or contemplate swimming under water because acid reflux and intense pain followed immediately.
Diagnosis
In early 2006 my eldest grandchild accidentally ran into me and, as I rubbed my chest, I felt a lump in what appeared to be an enlarged right breast. Whilst my doctor was not too worried about it he felt that it was appropriate to have it checked out and I duly had a mammogram – the only man in a waiting room full of ladies! As expected it was only fatty tissue but the consultant asked why I had been taking the prescribed drug for so long as this was a known side effect of long-term use. This was something I had never been told and I was less than pleased! I told him why and he was astonished. If the reflux pain was so bad, he asked, why not have the keyhole surgery that was available? Now it was my turn to be astonished – why had no one (my doctor?) ever told me that it was? He immediately referred me to a consultant who arranged a barium meal examination on 27 June 2006 and an endoscopy on the 11 July 2006. The results confirmed that I had a hiatus hernia and Barrett’s disease (see below) and the consultant, in turn, referred me on to Mr Mukherjee who, he said, was an expert in this area and could probably help.
He was right.
I was, after so many years of pain, about to get some help. I told Mr Mukherjee that the pain was so bad that it was beginning to reduce me to tears but that I couldn’t tell, since I had nothing to compare it with, whether I was being a complete wimp or whether the pain really was as bad as I thought it was? I was very relieved to hear him say that he didn’t doubt that in my case the pain was indeed very severe and that no, I wasn’t being a wimp!
After patiently listening to me relate my symptoms and concerns Dip Mukherjee arranged an Oesophageal Manometry and 24 hour pH investigation which I duly did on the 18 January 2007. This involved passing a small sensor via my nose and throat to monitor my gullet function. It was a little uncomfortable but not at all painful. When the first test was completed the second sensor was connected to a portable recorder the size of a ‘Walkman’ and I went home. I returned the data recorder the next day, together with my completed pH study diary sheet.
I went back to Mr Mukherjee the following week and he explained the test results and the situation very patiently, drawing diagrams and writing detailed notes that he gave me to take away to read (I still have them). He confirmed that the pH readings were very high both in a supine and erect state and that I had virtually no anti-reflux barrier. He suggested that the test clearly showed that I had severe gastroesophageal reflux disease (GORD) and a hiatus hernia.
The good news was that the worse the condition the more likely the chances of surgical success!
Treatment
All in all he recommended a ‘full wrap’ (360 degree) Nissen Fundoplication whereby he would wrap the top of the stomach around the gullet and stitch it in place thereby narrowing the hiatus and reinforcing the closing function of the lower oesophageal sphincter. This would ensure that whenever the stomach contracted it also closed off the oesophagus instead of squeezing stomach acids into it, which would give me (hopefully) complete relief from the pain I had been in previously. He carefully explained the risks inherent both during the keyhole operation (including the possibilities of bleeding, injuring the spleen and conversion to an open operation if things didn’t go to plan etc) and after the procedure (possibilities included flatulence and gas bloating caused by an inability to belch afterwards and difficulty in swallowing). It also meant that I would almost certainly never be able to vomit after the operation except in the most extreme cases such as food poisoning.
Of course the potential rewards far outweighed, in my mind, the risks and I readily agreed to the operation. After all those years of pain someone had finally told me that there was a relatively easy procedure that should greatly improve the quality of my daily life.
Mr Mukherjee carried out the keyhole procedure on 19 February 2007 – a date that now stands out in my memory! The operation took about four to five hours and I recall feeling a bit sore and sorry for myself the next day but went home within 24 hours.
I was then, he said, to be on a ‘liquids only’ diet for five to seven days following which I might attempt ‘soft’ foods. I would almost certainly find eating steak and especially bread quite difficult initially. He was absolutely right on those points and I still occasionally find that bread will stick in my throat until time and gravity resolve the problem! Other than that I have had no problems whatsoever though I am careful never to eat or drink to the extent that might cause me to feel sick.
One further problem was that the tests in 2006 had shown that I had Barrett’s disease caused by the chronic acid reflux damaging the cells of the oesophagus. Whilst this is permanent and is known to be a potential precursor to throat cancer there is considerable debate as to whether the damage remains, at the level it is already at, or whether it gets progressively worse. Only time will tell. I had endoscopies in September 2007 and November 2008 with no worsening of the condition. I have just had another one (November 2010) and am awaiting the biopsy result but have no immediate concerns. Assuming the position has not worsened I will have further endoscopies, probably for the rest of my life, every two to three years – a small price to pay.
A new life
To all intents and purposes from that day (nearly four years ago now) to this I have had no acid reflux and no pain – to my mind it was a miracle! Indeed I can hardly ‘recall’ the amount of pain that I was in. At 59 years of age I can now roll about on the floor playing with my seven grandchildren, eat what I like when I like and sleep flat if I choose to. I would certainly encourage others who have similar symptoms to take expert advice and find a consultant surgeon as good as mine.
Every time Mr Mukherjee carries out my precautionary endoscopy I tell him again how thankful I am that his skill and expertise, quite literally, changed my life.