Damage to Vagus Nerve After Laparoscopic Fundoplication

[Evo]

Now my doctor is thinking my previous laparoscopic nissen fundoplication damaged my vagus nerve. This wasn't on the list of potential surgical problems I was given. I'm reading about it and it seems that damage from the surgery is now considered rather common?

It's not like I had much choice, without the surgery the continual aspiration of vomit during sleep was likely to kill me.

And now that my surgery got torn from dry heaving, the vomiting is returning.

The gastroenterologist confirmed the need to do reparative surgery, but thinks it is too risky.

To anyone with GERD that is considering surgery, be sure to do research on post operative studies in addition to what your surgeon tells you.

I'm hoping I just have furballs (bezoars) that can be removed and will reduce the pain some, but that seems to be something that would need to be done forever?

So gastroparesis due to vagus nerve damage and possibly intrathoracic migration of the wrap (tests need to be done). http://www.ajronline.org/cgi/reprint/178/4/859.pdf

 

[Monique]

I'm sorry to hear that. Is there any indication that the function of the nerve might improve over time?

 

[Evo]

I'm sorry to hear that. Is there any indication that the function of the nerve might improve over time?

I've only read of an improvement in the case of diabetes as the cause. In the case of surgical damage, all I have read said there can not be improvement. Rather discouraging. I read that they are experimenting with botox in the case of gastroparesis caused by vagus nerve damage, but it hasn't been studied.

 

[nismaratwork]

If you truly were not warned about this possibility, this would be a good time to find a lawyer. That aside, if there is minor damage of the nerve, it CAN heal... very very very slowly. If the damage is more than a microscopic "nick", or the kind of diffuse lesions from diabetes, then no it will not heal.

I'm sorry that this happened to you, and please be careful; the Vagus Nerve can cause arrhythmia, rare as that is in the case of damage rather than momentary insult or injury. It is possible that the nerve has not been damaged, but is inflamed or that some scar tissue is impinging on it too, which WOULD be something that can heal. Have you been placed on a steroid or NSAID?

Again, I'm truly sorry to hear of something like this.

 

[Evo]

If you truly were not warned about this possibility, this would be a good time to find a lawyer. That aside, if there is minor damage of the nerve, it CAN heal... very very very slowly. If the damage is more than a microscopic "nick", or the kind of diffuse lesions from diabetes, then no it will not heal.

I'm sorry that this happened to you, and please be careful; the Vagus Nerve can cause arrhythmia, rare as that is in the case of damage rather than momentary insult or injury. It is possible that the nerve has not been damaged, but is inflamed or that some scar tissue is impinging on it too, which WOULD be something that can heal. Have you been placed on a steroid or NSAID?

Again, I'm truly sorry to hear of something like this.

My stomach isn't emptying, the nerve may be completely cut, we don't know yet.

 

[nismaratwork]

My stomach isn't emptying, the nerve may be completely cut, we don't know yet.

Oh crap, well, I for one am hoping that isn't the case Evo. I don't think much can be said here, but, I'm rooting for you on this one.

 

[ViewsofMars]

Thanks Evo. I followed the link here from the food thread.

I did locate at LiveStrong the following:

What Are the Causes of Vagus Nerve Damage?
Surgical Complications
Mayoclinic.com states that the vagus nerve can sometimes be damaged during surgery to the stomach or small intestine.

A procedure called laparoscopic hemifundoplication, which is used to treat gastric reflux, has been associated with vagus nerve damage, according to Dr. Maud Y.A. Lindeboom of the Departments of Gastroenterology-Hepatology, Surgery, and Nuclear Medicine at the Leiden University Medical Center in the Netherlands. Patients saw a remission of their reflux symptoms after surgery, but 10 percent of patients who'd undergone the procedure showed signs of postoperative vagus nerve damage.
http://www.livestrong.com/article/148586-what-are-the-causes-of-vagus-nerve-damage/

I happen to be a big fan of Mayo Clinic. I subscribe to Mayo Clinic Health Letter. (www.HealthLetter.MayoCinic.com)

I went online to Mayo Clinic that discusses gastroparesis.

Causes
By Mayo Clinic staff

Stomach and pyloric valve

It's not always clear what leads to gastroparesis. But in many cases, gastroparesis is believed to be caused by damage to a nerve that controls the stomach muscles (vagus nerve).

The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can't send signals to your stomach muscles. This may cause food to remain in your stomach longer, rather than move normally into your small intestine to be digested.

The vagus nerve can be damaged by diseases, such as diabetes, or by surgery to the stomach or small intestine.
http://www.mayoclinic.com/health/gastroparesis/DS00612/DSECTION=causes

The link above provides to the left of the page information which should be helpful in this discussion:Definition, Symptoms, Causes, Risk factors, Complications, Preparing for your appointment, Tests and diagnosis, Treatments and drugs.

Mayo Clinic is on the cutting edge of treatments and drugs. http://www.mayoclinic.com/health/gastroparesis/DS00612/DSECTION=treatments-and-drugs

Here is a snippet from the following link, "Mayo Clinic physicians have been at the forefront of gastroparesis diagnosis for half a century. Today, they use sophisticated tests to evaluate the entire digestive tract, measure motor and sensory function in the stomach and intestine, and check for antibodies associated with motility problems. These advanced studies not only diagnose gastroparesis but help distinguish it from functional dyspepsia — a condition that causes similar symptoms."
http://www.mayoclinic.org/gastroparesis/?mc_id=comlinkpilot&placement=bottom

 

[dlgoff]

I don't want to continue hijacking the food thread, so I will post updates in the vagus nerve thread, which should be renamed "Why is Evo so cranky?"

I'm going to be very careful in my posting l until I know you are feeling better. I've got a couple of GOOBF cards left though.

Good luck Evo.

 

[Evo]

I'm going to be very careful in my posting l until I know you are feeling better. I've got a couple of GOOBF cards left though.

Good luck Evo.

The PF chat group has immunity. Also, lisab, at last count, had over a billion GOOBF cards, with no expiration date. The details of how she came into such a large number of cards escapes me. She swears that I gave them to her, all I remember is her handing me an odd tasting drink...

 

[Evo]

I happen to be a big fan of Mayo Clinic. I subscribe to Mayo Clinic Health Letter. (www.HealthLetter.MayoCinic.com)

The Mayo Clinic site is my favorite!

I had not seen that article from livestrong, thank you!

Funny, if it's not gastroparesis, it may be the opposite - Dumping Syndrome. I refuse to have something called "Dumping Syndrome".

http://www.mayoclinic.com/health/dumping-syndrome/DS00715/DSECTION=symptoms

The doctor did say that my wrap has slipped, possible rupture, etc...

 

[Math Is Hard]

Are any of those things they told you to try helping? I seem to remember they said no drinking with meals, lying on your side after meals, no spicy or citrusy foods...

 

[turbo]

Are any of those things they told you to try helping? I seem to remember they said no drinking with meals, lying on your side after meals, no spicy or citrusy foods...

I would die! Life without spicy food would be unthinkable for me. I hope for the best, Evo, so you can regain some normalcy in what is a basic function and pleasure in life.

 

[Evo]

Are any of those things they told you to try helping? I seem to remember they said no drinking with meals, lying on your side after meals, no spicy or citrusy foods...

Lying on my side eases the pain, but I have to drink while I eat because of the extensive scarring in my esophagus, without water it's like swallowing a cat with it's claws extended.

I would die! Life without spicy food would be unthinkable for me. I hope for the best, Evo, so you can regain some normalcy in what is a basic function and pleasure in life.

When my mother had to cut all seasonings out of her diet, I swore I'd die before I lived like that. Tasty food is one of life's greatest pleasures.

 

[Proton Soup]

yikes, sounds awful. i had reflux for years. it has damaged my teeth, and I'm pretty sure is the cause for the ear/sinus damage i constantly suffer from now.

if you are on acid reducers, then i hope you are taking B12 supplements, as it will reduce absorption of B12 bound to meat. low B12 will not only impair the ability of nerves to repair themselves, but will eventually lead to neural damage. fortunately, the GERD seems to be gone now, but the damage is long-lasting, and only somewhat better.

oh, and since you seem well-funded, maybe seek out a neurogastroenterologist.

 

[michael7140]

I had the Lap. nissen fundoplication done also, in June of 1999. I ended up with all the horrible symptoms you mentioned, the horrible pain, nausea, “intense” dry heaves, diarrhea. I told the surgeon about them from my very first follow up. It did not go well, to say the least. For the next “7” years, I went from doctor to doctor. Each one saying the same thing, of course “after” ordering their own “CT” scan, “I don’t know what the problem is, but it was not caused from the surgery.” Well to make a long story short, 7 years and THOUSANDS of dollars later, my wife and I end up at the Cleveland Clinic. We walk in and within two minutes of meeting the doctor, he diagnosed me. ”Your problems are from your surgery”. They damaged the vagus nerve by doing the surgery by laparoscopy. You are at least the third patient this week with the same problem.”
The plan was to “redo” the surgery, only “open” instead of lap. His hope was that by loosening the wrap would ease up any tightness and pulling or pinching the vagus nerve. After surgery, and after removing part of my stomach, because it was such a sloppy job the 1st time, I was informed that the vagus nerve was cut and nothing could be done. It has truly been hell, personally, financially, for my family, you name it. I feel like I am living a nightmare.

 

[Evo]

Sorry to hear that you've also gone through this. It's so painful and so disruptive to your life.

 

[dlgoff]

I had the Lap. nissen fundoplication done also, in June of 1999. I ended up with all the horrible symptoms you mentioned, the horrible pain, nausea, “intense” dry heaves, diarrhea. I told the surgeon about them from my very first follow up. It did not go well, to say the least. For the next “7” years, I went from doctor to doctor. Each one saying the same thing, of course “after” ordering their own “CT” scan, “I don’t know what the problem is, but it was not caused from the surgery.” Well to make a long story short, 7 years and THOUSANDS of dollars later, my wife and I end up at the Cleveland Clinic. We walk in and within two minutes of meeting the doctor, he diagnosed me. ”Your problems are from your surgery”. They damaged the vagus nerve by doing the surgery by laparoscopy. You are at least the third patient this week with the same problem.”
The plan was to “redo” the surgery, only “open” instead of lap. His hope was that by loosening the wrap would ease up any tightness and pulling or pinching the vagus nerve. After surgery, and after removing part of my stomach, because it was such a sloppy job the 1st time, I was informed that the vagus nerve was cut and nothing could be done. It has truly been hell, personally, financially, for my family, you name it. I feel like I am living a nightmare.

Sorry to hear that you've also gone through this. It's so painful and so disruptive to your life.

I don't know what to say so I'll just cry for you both.

 

[mazinse]

I am sorry to hear that. I must ask why did you opt for surgery for something like GERD. Couldnt you have taken the PPI's or anti nausea medications. Even the most expensive PPI like Protonix is still cheaper than the surgery. I am sure those options were offered right.

 

[michael7140]

It started with GERD, then I was diagnosed with Berits esoph. and they said I had no other options.

 

[mazinse]

It started with GERD, then I was diagnosed with Berits esoph. and they said I had no other options.

what grade was the dysplasia, was surgery recommended by your GI doctor, or did your surgeon recommend it.

 

[michael7140]

what grade was the dysplasia, was surgery recommended by your GI doctor, or did your surgeon recommend it.

The doctor never gave me a “grade” for the dysplasia, and I didn’t know to ask. The Barrett’s was diagnosed by the same GI doctor who recommended the surgery. But I was told once, during one of my ‘many’ follow-up endoscopy’s, that once you have developed a ‘Barrett’s’, you always have it. I am not sure if this is true or not, but it made me wonder if I was diagnosed appropriately in the first place. But good luck trying to get one doctor to admit that another doctor made a mistake, it will not happen. Not in my case anyway. I believe that is why it took me so long to get any help after the surgery, and even now whenever I go to the doctor for help with the symptoms. To say some of the doctors had an ‘attitude’ would be an understatement! You would not believe how I have been treated by some of the doctors. This entire situation has been, and continues to be hell on both me and my family both financially and emotionally. I HATE the way I feel, and what this has done to my family.

 

[Evo]

My surgery was done because I was vomiting in my sleep 2-3 times a week and I'd wake up choking on my own vomit, even though I was sleeping sitting up and had been on Prevacid for years. It's a good thing I was such a light sleeper. But coughing vomit out of my lungs for 1-2 hours each time convinced me I needed surgery. Of course, the surgery was botched. The wrap was too tight for starters. Had I understood the problems associated with the surgery, I would have shopped around for a surgeon that was experienced with the procedure.

 

[michael7140]

Evo, can I ask how long ago did you have your surgery? Also, how long after that original surgery did you find out that something went wrong, and how did you find out?

 

[Evo]

Evo, can I ask how long ago did you have your surgery? Also, how long after that original surgery did you find out that something went wrong, and how did you find out?

I had the surgery in June of 2008 and the problems were immediate. A nightmare getting anyone to admit what was wrong.

A thread about the problems here. https://www.physicsforums.com/showthread.php?t=520982

 

[mazinse]

Do you need to take anything to improve peristalsis or antinausea meds like reglan or zofran. How is your larynx / voice right now, I hope the vagus nerve damage didnt reach there.

 

[michael7140]

Do you need to take anything to improve peristalsis or antinausea meds like reglan or zofran. How is your larynx / voice right now, I hope the vagus nerve damage didnt reach there.

I take immodium, lomotil, zofran & oxycontin. Before they started me on lomotil, I would take up to 24 immodium every day. Now I take 10 lomotil and up to 6 or 8 immodium everyday, and still have problems. I have not had any problems with my voice or larynx, thankfully. The zofran does help, but I still get 'intense' heaves a few times a week.

 

[michael7140]

Thank you, but after all these years, I do not see things getting any better. The #1 part of this that I hate the most, is the affect it has had on my family. The 2nd part is finding a doctor who 'listens' and does not treat me as if I am making it up, which I don't understand why anyone would want to make up something so horrific.
Whenever I would go to a doctor, I used to think that they would have an attitude and be angry with me because I had the “nerve” to complain that another doctor did something wrong. I no longer ‘think’ that, I ‘KNOW’ it! I have and continue to be treated as a third class citizen at best. I feel COMPLETELY helpless. At times it feels like I had the “perfect” crime committed against me, the only difference between this crime and others is everyone knows who committed mine. And yet there is not a damn thing I can do about it. I just don’t know what to do anymore.