View Full Version : can a Nissen come "undone"?

05-04-2009, 08:21 AM
Gabriel had his Nissen in January 2008, but he's been able to vomit for a few months now. Lately, I've noticed that he's been arching and crying, and I'm wondering if his reflux is back. Has anyone had to have a Nissen repaired? What tests do the surgeons do to see if the Nissen is still intact? Thanks!

My little figther
05-04-2009, 09:17 AM
Yes a Nissen can become undone - a GI trach study with barium is usually done - Cedric's did not become completely undone but slipped a little and made it a little loose.

We may want to call you GI doctor and see what he recommends.


05-04-2009, 12:25 PM
As Michelle said, yes, it certainly can slip or come completely undone. Most surgeons dont undertake a nissen repair lightly; they usually do a milk study (done in nuke med). Our GI team wouldn't even consider the surgery without a ph probe study being done...seems that's the gold standard. I really hope that you can figure out what's up.

05-04-2009, 02:11 PM
He has a swallowing study scheduled for Monday, but I'm going to ask about the pH probe, too. He never had one done when he was evaluated for reflux last winter.

05-04-2009, 04:24 PM
pH probe tests are notoriously unreliable in cases of reflux. My son had two, and despite the fact he was vomiting several times a day and clearly had reflux, the tests came back negative/inconclusive. He's not the only child on this board to have had those results despite clear clinical signs of reflux.

The milk study is relatively easily done. He had that done to check for aspiration (negative thankfully!).

I hope Gabriel's not too uncomfortable in the meantime. Looks like you'll have to keep him propped up again for feeds and for a while afterwards, in order to keep him comfy.

My son's fundo has definitely come undone or loosened enormously because he burps like a trooper during meals now. I haven't done anything about it because he's clearly not uncomfortable, but if he complains of anything I'll be straight onto his GI doc.

Good luck!

05-04-2009, 05:09 PM
Luke had a "normal" PH probe even though he clearly has reflux and vomiting. And having the PH probe done was a pain - probe down the nose, Luke pulled it out and we couldn't get it back in, so we had to stay in the hospital for 2 days instead of 1, and the 2nd day he had to have socks on his hands the whole time. We also found out later that our insurance wouldn't pay to have the PH probe read. That was a $500 bill that I hope Medicaid covered and isn't a surprise later.

You might want to see about having an upper GI done before a PH probe. For that they would put barium in one of Gabriel's feedings and then check under fluoroscopy whether or not he was refluxing the feeding. I am sure no test is fun, but it would be quicker than the the PH probe. I don't know if the swallow study would give you that much info about reflux. In the ones Luke has had he is not fed enough to cause reflux and it focuses on the head and throat area, not so much further down.

Is Gabriel still on reflux meds, so that if he is refluxing at least it is not acidic? I hope you can get it figured out soon.

05-04-2009, 10:38 PM
Ayden's 1st nissen came undone within 6 months. His 2nd one still is intact, even though he can vomit. The difference between the first time and now, is that he would projectile vomit and get upset.

You will need to schedule a nissen study where they fill the tummy w/ barrium and see if it comes up sitting up and laying down.

05-05-2009, 08:19 AM
I didn't think the swallowing study would be very useful, since it only focuses on his throat area, but we still have to have it to make sure he's not aspirating the little amount he's taking orally. I'll ask about the upper GI...it definitely sounds better than the pH probe.

Gabriel isn't currently on any reflux meds, but if he continues to cry and arch, I'll see about getting him a RX. He's been fine since yesterday, so who knows what was wrong????

05-05-2009, 07:49 PM
Sydney's first Nissen didn't work at all - she developed a paraesophageal hernia, which caused the wrap to be totally ineffective. Here in Rochester, they told us they did not re-do Nissens. We went to Cincinnati last year, and they said they recommended it. We had her second one done in Cincinnati about six months ago. She still vomits all of the time, so bad in fact that we still use a GJ tube to get her nutrition in. But, it must have worked somehow, because all of the tests say her reflux has improved, and her bronch results have showed less reflux into the airway.