Questions & Answers

Should I Get Nissen Fundoplication Surgery For GERD Acid Reflux Surgery?

It’s week four of the lockdown, isn’t it crazy? I trust everyone out there is having a good time and taking it easy and not stressing too much. I suppose it depends on the country that you’re in. I’ve got lots of stuff to go through today, all sorts of questions from people.

Let’s start off with an interesting one here, a question I get asked quite a bit. It’s about these operations for the stomach, for the gastroesophageal reflux operations or GERD. Heartburn, acid reflux, this kind of stuff. Many people complain about this. Millions and millions of people in the United States have this symptom every single day of the year and it’s bloody terrible. I used to have this when I was in my twenties because I did dumb things. Dumb things lead to, often dumb consequences like pain or things like that. I’m not saying that all cases of GERD are caused by doing silly things, but I could easily say the vast majority are. Like what I did, I was stupid, I was young. I used to drive a truck in my twenties, come home, this is before I studied, I’d have a can of Coke and I’d have a pie or something from the bakery for breakfast. Then an hour later I’d get this terrible heartburn, until I realized it was my own stupidity.

Now here’s the question, should I get Nissen fundoplication surgery for GERD. Nissen fundoplication is a weird term, but it’s a term that’s used for a particular type of operation that’s completed on the stomach, on the top of the stomach. Basically they wrap a small part of the stomach around the bottom of the esophagus where it meets onto the stomach. This tightens that top of the stomach up more. Because you’ve got this sphincter or this muscle, a sphincter is a round muscle. You’ve got one there on top of the tummy right at the bottom of the esophagus called the lower esophageal sphincter, funny that, it’s called LES. When LES isn’t happy, LES isn’t going to really stay closed for a while and LES is going to open his mouth right up, and then LES is going to allow stuff from the stomach to come into the esophagus and that’s going to give heartburn. Sometimes you can feel it here in the chest. Sometimes guys get this and think they’re having a heart attack when in fact what they probably had are three Big Macs or some greasy crap to eat half an hour before.

When you get heartburn, the key thing I would ask you if you were a patient, how long have you had it for? When do you get it? How often do you get it? When did it start? What kind of job you got? What are you eating? Because usually there’s one big problem with GERD and it’s this thing, it’s called the mouth. There’s something wrong with the mouth. It can’t seem to stay closed long because too much stuff goes in here. Too much food goes in here. When there’s a problem with the mouth, eventually you’ll get a problem with the stomach. But the problem goes beyond the mouth, it’s probably up here somewhere, probably emotional stuff. I don’t know why people eat half the crap that they do, but often eating the wrong kind of food, eating too much food is the problem with GERD. So that’s the problem, you’ve got to watch out what goes in the mouth, how it’s chewed, how much you eat.

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For example, with this COVID-19 lockdown, I’ve cut down to two meals per day, and I’ve done that now for the last four weeks. You don’t need three, four meals in a day, especially if you’re sitting on your butt in your own property and you’re not moving around much. So too much food is the first thing I think about with GERD, too much food. The wrong kind of food. Inappropriate food, fatty meats, lots of alcohol, large portion sizes, far too much bread. Lots of peanut butter and jelly sandwiches. One patient I had, I’ll never forget this patient from the United States I had, but it could have been Germany anywhere, and this person’s main diet was peanut butter and jelly sandwiches. Well, that’s not really a good idea, is it? So these are the things often that lead to GERD, and of course obesity can push you in there even further.

So should you get this operation? If you’ve got to heartburn, it really depends on how bad the situation is. You could have also some erosion in the lower part of the esophagus from too much acid, and that can even push you sometimes into a cancer state. If you have got GERD, there are natural solutions for it. There are ways you can mitigate these symptoms and calm them down. But this is the kicker, if you’ve got a lot of weight on your frame, you need to get it off, because otherwise it’s not really going to help you much. These are the things that need discussing and working out.

All the years I saw patients, there were only two people I really requested that they get surgery, esophageal surgery, basically like this. In both cases it worked brilliantly, but these were very, very large people who couldn’t even walk from literally here to the door without their knees being in severe pain. So it was life or death, but in most cases it’s not like that. So should you get it? I don’t think you should. I think you should look at alternatives, I think you should try and lose weight first, make some changes. I’ve seen many people successfully get rid of their heartburn and lose weight and change their diet and not have this dreadful symptom anymore. It’s totally achievable, but remember, the ball’s in your court, it’s up to you. You don’t need the surgery if you don’t want it, but you’re going to have to work through some stuff.

The other part I’ll leave you with, which I’m not happy about, once a person has had surgery of course, their whole life changes. They can never really eat reasonable portion sizes again. They’re usually down to small portion sizes. Surgeons often don’t tell people how dreadful those first three to six months or a year can be after this operation. It’s not really nice. Socially, it won’t be nice for you going out. It won’t be nice for eating at home and people come over. You’ll suffer emotionally for a while until you get used to that. All the more reasons not to really get this operation done if you can avoid it. But for other people who comment on this video will say, “Look, it was a miracle for me”, and it probably is, but you don’t need to get there in the first place. This could all be avoided by lifestyle and diet, simple. Take care.