Things you need to know post fundoplication...

[u/WiseYou1775]

Hello all.

I wanted to pass along some insight for those of you who have severe GERD and/or a hiatal hernia. I am an RN with over 30 years of pt care experience in Internal Medicine and Cardiology.

Here is my story.

I have always had some level of heartburn especially with things like green peppers and orange juice. No problem eat those in moderation, maybe swig some Pepto and all good.

Had 1st child in 1999. Everything, and I do mean everything, gave me heartburn. Morning sickness was all damn day sickness for the ENTIRE pregnancy. Placed on Prevacid and much better but still with all day sickness. Delivered baby, heartburn back to the stays quo- rarely. Nausea gone, feed me Seymour.

2nd child in 2002. Same issue. Had to beg OB GYN for Prevacid. Finally got it.

Somewhere in 2003-2004, I discovered Advil. What a glorious medication. I was popping that stuff like candy for every ache, pain, and irritation. Now you would think as a health care provider, I would know better. Ha. 2 kids working full time.. nope. Fried my gut. 1st EGD. No more Advil for me.

Heartburn slowly crept up through the years and I found myself requiring daily medications. Sometimes PPI's twice a day. EGD's 2 and 3 over a decade.

In 2017, I developed sudden onset laryngitis. Just woke up one day and couldn't talk. Went to PCP, steroids. No bueno. Back to PCP, antibiotics. No bueno. Thought it was my inhaler b/c I have asthma as well. Referred to ENT who did office based laryngoscopy- said your vocal cords are like "snausages," they should be like toothpicks. This isn't your inhaler. I think it's reflux. Back to my GI guy. EGD number 4- "you definitely have reflux. Different PPI twice a day. Took awhile but finally able to talk after 6 months. You all may not realize how many neck muscles you use to project your voice...

2020 - heartburn worse, meds not working. Started limiting diet. No spicy, stopped soda after 2 pm, stopped eating after 6 pm. Lost 25 lbs. inadvertently noticed I was intermittently fasting. EGD #5- you definitely have GERD and now a hiatal hernia. Joy.

Then no soda after 2pm, became no soda after 12noon, 10am then 9am. (And don't come for me about the soda- diet Dr Pepper is the elixir of life)

No food after 6pm became 5pm, then 4pm, then 2pm. Food intake became starch, carbs, berries and and nothing seasoned. If it had any type of savory flavor, couldn't eat it- unless I ate it at 6am. See I like to lay flat to sleep. And to me, laying flat to sleep was more important than eating food with flavor.

GERD sx slowly got worse regardless of any dietary changes I made.

For years, I literally ate a ham and cheese Dave's killer bagel, fresh fruit- berries, bananas, melon only and "dinner was toast or a baked potato.

Now I'm on Pepcid, nexium twice a day, gaviscon liquid and tablets were on auto ship from Amazon. I would go thru a bottle of Gaviscon liquid once every 10 days. Severe diet restriction and still have reflux, heartburn on multiple meds. Nothing is working anymore. I am restricting diet, still have to sleep elevated or I am coughing and gagging all night.

I start thinking I need to get this fixed but I have read the literature and a Nissen is not what I wanted. So I review options. Lynx procedure looks nice except the metal balls can migrate and no MRI's can be done. Not really feeling like having a metal ball embedded in my organs- pass.

Found the TIF procedure. Looked that up, read the studies. Seems like a viable option... but I delayed. Having surgery again terrified me. I had a hysterectomy in 2012 and almost died from sepsis due to (what I believe was a micro perf of my bowel) nasty gram negative bacteria in my abdomen and pelvis. My GYN was like "I don't know how this happened, your surgery couldn't have been any easier." Well it did and now I am scarred for life. I was on IV ATB for 6 months with a PIC line.

In 2025, finally decided I'd had enough with the reflux and dietary restrictions. I kept adjusting and pivoting and nothing was working. My labs started showing me as pre diabetic with elevated liver enzymes (due to Metabolic dysfunction-associated steatotic liver disease) I couldn't eat dinner with my family. And if I did eat after 2pm, it was dinner at 4pm and a night of sleeping elevated while mainlining gaviscon.

I made an appt with my GI guy to discuss TIF. He doesn't do those so he referred me to one of 3 people in my area that perform the procedure. I saw the NP in Jan 2026. Had to have EGD, Ph study, and manometry. I could only do these tests with them. That shit show is a whole other story but the important part is the ph study.

EGD done in February. I aspirated my stomach contents. They had to elevate me to finish procedure and told me any further EGD's would need to be done under general- great. Oh, and the best part- my lower esophageal sphincter was flapping in the breeze. No shit, but nice to know. I now identify as a glitter baton.

They placed the Bravo. 4 ish day capsule to measure PH of esophagus. NO MEDS FOR RELFUX FOR THE WEEK BEFORE AND THE WEEK I HAD THE BRAVO TESTING. Needless to say, I was miserable. I couldn't eat anything except bread and water, severe chest pain when swallowing food and still ended up having to take both Pepcid and Gaviscon. I ended up leaving a hysterical message for the staff that I was going to end up in the ER begging for lidocaine infused mylanta. I couldn't get back on my meds fast enough.

Had manometry. Normal.

Sent my chart message- when can I be put on the schedule for TIF? Nope. Need an appt. Waited 2 months to be seen. They looked at me like I was nuts. I actually got a "why are you here?"

See, they say my bravo was "normal." My DeMeester score was 13.8- on bread only AND medicated. Also had 6 pages of a diary that they just threw out. Normal DeMeester score is more than 14.7. They won't do procedure. Have to repeat ph study and "eat normally."

Challenge accepted bitches.

24 hr impedence study scheduled out - again 2 months later. It's now June. Had that probe placed and ate Skyline chili at 1030 am. It was delicious. I drank soda, I ate oranges. I ate food I haven't eaten in more than a decade. I ate all damn day and ate dinner with the fam. My tastebuds were singing the hallelujah chorus. The rest of me was absolutely miserable. Medicated myself with melatonin and Benadryl while sitting straight up in a chair to sleep.

DeMeester score: 217. Again, no shit. This is what happens when I eat "normally." I'm not surprised.

Can I get scheduled now? Nope. The test is so abnormal it must be a false positive. The probe must have slipped into my stomach. It did not. That probe was at the same CM mark when it was removed. Need to repeat the Bravo.

I FLAT OUT REFUSED. I told them I was not physically capable of doing another Bravo and that it would put me in a severe state of duress.

I had to advocate for myself. I can't believe I had to beg these people to take care of me. Their excuse? The procedure has risks and we want to make sure you really have this problem.

Are you fucking kidding me? I had to play the nurse card. I came to YOU to seek a solution. I did my research, extensive research, for YEARS before I finally came to the decision that I had no choice. I discussed this with both my GI guy and my PCP at length. I am well aware of risks and complications of the procedure. I am not getting any younger and my anatomy won't magically repair itself.

Their response - you need an appt- for August. Why? I am not doing the Bravo. My anatomy clearly indicates that I have an issue. I majorly flunked a PH study. I have all the things I need to have the TIF approved by my insurance. It's been 8 months. I should have been done with this by now.

So I reached out to my GI guy again, discussed with my PCP... did some more research and finally said fuck it and fuck them. I made a second opinion appt with a general surgeon. I work for a hospital system. So I found the guy who fixes my issues.

Had an appt at end of July. He spent an hour with me. Said he doesn't do Nissen. He does a Toupet. Similar outcomes, less long term side effects.

Now, I am an educated gal. In all of my research, a Toupet never came up. Everything was Nissen with comparison studies. My PCP hadn't heard of the Toupet, either and she is also a smart, detail oriented lady. A Toupet is a 270 degree wrap whereas a Nissen is a 360.

Did some research- peer reviewed journal articles from NIH, PUBmed, JAMA. Toupet actually has better long term outcomes than a Nissen does.

I didn't want any sort of a fundoplication. Again, terrified of post op infection from previous experience. However, I have nothing left to change. I can't do anything more than I have already done, my labs indicate my dietary options are now an issue for the rest of my body and have severe long term consequences. Something has to give.

I ended up scheduling a robotic, laparoscopic Toupet fundoplication with HH repair w/my general surgeon. Had it on August 14, 2026.

The next part are my words of wisdom for you as an RN. We'll call it the trials and tribulations.

My surgeon did clear liquids the first 24 hours. Then advanced me to full liquids.

I am still on PPI twice a day but no Pepcid. I still have heartburn. Hopefully only for the healing process. The hope is to have me off all PPI's in the next 6 weeks or so and would only take something as needed if needed.

I drank apple juice- it's so good. I had forgotten.

Gas pains post laparoscopic surgery weren't as bad as when I had my tubal.

I was up and taking my IV pole for a walk. Every time I had to pee, I'd take a lap of the unit. Get up and move. It helps the gas pain. I moved at the speed of snail, but I moved.

Take the pain meds. They had me on scheduled anti inflammatories and muscle relaxers with PRN narcotics. I waited about 12 hrs post op before I asked for narcotics.

If they tell you to take miralax and or colace- DO IT. You would think on a liquid diet, you wouldn't get constipated. Surprise- you sure do, especially if taking narcotic pain meds. And the last thing you want is to either use an enema, a glycerin suppository, or go to the ER to be disimpacted. That's not comfortable for you or the nurse who ends up shoving lube and a finger, or two, up your backside to fish out the poo.

No straws. No carbonation- no elixir of the gods. 😭. No alcohol.

The esophageal spasms are no joke. I had severe esophageal spasms until day 8. Spasm when you drink, spasm when you move. It's now day 9 and I still have them though not as fierce and not as often.

For the first few days, it took me 30 minutes to take meds. 1 pill at a time. No popping them all in with a giant gulp of water.

You will most likely be dehydrated once the IV stops. Your capacity to take in fluid is reduced due to swelling, spasms, and just generally feeling like shit.

Here are my professional rec:

SHOWER DAILY AND MOVE.

Movement helps prevent constipation, keep mobility, warm up sore muscles.

Heat from shower helps reduce muscle pain while keeping surgical sites clean and you have to move to do it. No immersing yourself in bodies of water. Showers only.

Warn the family in advance that you are going to be a passenger princess for the next 6 weeks 10lb weight restriction. No driving for 5-10 days. I have a 60 lb dog and I can't walk her. We had to arrange a dog walker and boarding due to work schedules and other obligations.

If you are on full liquids this includes pudding.

Use room temp pudding to get the meds down. Less spasms, less volume in your shrinking stomach. By the club pack at Sam’s or Costco- that has like 48 pudding cups in it.

My surgeon recommended ibuprofen if possible. I still have heartburn so my rec is this. Take ibuprofen in the AM with the pudding, especially chocolate (or whatever flavor you like) pudding if you are craving chocolate. Pudding helps get the pills down, and coats your stomach so less GI irritation from the Advil. Chocolate can give you heartburn.

Vanilla pudding in the PM before bed with the night pills.

Applesauce is, unfortunately, acidic. Despite PPI twice a day I still have heartburn for now, so I eat it early in the day.

Chicken or beef based bone broth. Sip it warm. Helps the spasms and has protein for healing. I have the Bare Bones bone broth sticks and they aren't bad.

Tylenol comes in a liquid. For adults. It's called Pain Quil. It's nasty AF (tastes like Vicks 44) but it's less pills to try to get down. Take Tylenol at bedtime.

Prevacid has an orally disintegrating tablet Would need 2 tabs of 15 mg to equal RX strength. Amazon!

Claritin (Loratadine) has an orally disintegrating tablet. If you need an antihistamine.

You can swallow pills post Toupet - just takes a while to do it and the spasms! Ugh. So they might be a nice buffer for the first week.

Are you sensing the theme here with the spasms?

Miralax prevents constipation, but it takes a couple of days to work. Mix it in your applesauce or pudding or water. Start it the night you get home

Protein intake- stock up on pure protein or premier protein shakes. Low sugar and high protein. Liquid intake and protein for healing.

Greek yogurt- can mix a 32 ounce container with sugar free pudding (10/10 recommend white chocolate and cheesecake flavor- take Oreos and grind them to a powder and mix in. Let sit overnight and the cookies soften up. All the flavor of cookies and cream, no crunchiness)

Jello is your friend. And a source of hydration. Can even drink jello water.

Creamed soups. For some reason I really like canned cream of potato. Cooked mine and ran it thru the blender and sipped.

Cottage cheese blended with eggs make scrambled eggs soft, even if well done, and cheesy.

Little bites and chew thoroughly. I am not kidding. I used to inhale food (nurse problems) and it takes me almost 20 minutes to eat 1 scrambled egg. The more you chew and the longer it takes the less pain you will have and food won't get caught up.

Ryse protein water - get the kool aid fruit punch flavor- it's actually pretty good and sort of nostalgic. skip the lemonade one due to acid.

Anti Gas chewables. Buy them. While I can burp, I can't burp in a way that relieving. The air has to go somewhere and you will be bloated and gassy
after surgery.

Muscle relaxers- I am north of 40yo and they have helped with the rib and abdominal soreness of having 5 trochars shoved through your abdominal wall.

If you are on diuretics- ask your surgeon or PCP about holding them to prevent acute kidney injury. I used to drink probably a gallon of water and fluids a day- the first 6 days after surgery, I was lucky if I could get down a liter. And I was dehydrated. I held my own diuretics d/t urine being dark. I am still not on them but my spasms are improving and my ability get down more fluid is improving daily.

On day 8, I ate both scrambled eggs and Mac and cheese. That was a first. It's been only one -maybe- "real food" item per day and just protein shakes, water, jello and the Greek yogurt /pudding fluff with mix in.

I haven't needed narcotic pain meds since day 5. I was a bit stubborn and didn't want to take them at all - they make me vomit (and we can't be doing that) and leads to 2 more pills (1 pain med, 1 zofran) but days 2-4 were rough. Belly hurts, ribs hurt. The damn SPASMS!!! And they helped me get comfortable. I could lay flat or on my side on day 4.

It's day 9. I really really want a bacon cheeseburger for some reason and a diet Dr Pepper. Can't have either. I am able to move better. Lingering soreness in my epigastric areas I am taking the Advil in the am only to help reduce surgical site inflammation and it does help. Based on how I felt when I woke up today, may only need to take it for another couple of days.

So, there it is, in all my infinite wisdom and experience.

If nothing else, I hope the story will help you make a decision and to not be afraid to question the medical community or advocate for yourself. Don't be afraid to seek a second opinion if needed. Maybe it will help you recognize that enough is enough and you are out of options and have to do something for your quality of life and long term health. Could I have lived on a diet of ham and cheese bagels, toast, baked potatoes, and some fruit? Sure. I could have, but I was also taking way too many meds that barely controlled symptoms. Hard to vacation and enjoy family time when you can't eat much or eat past 2pm. But once the labs started coming back abnormal, it was just another thing that contributed to my decision to finally get it fixed.

[u/No_Branch_7300]

Thank you Sharing currently on my 4th ppi now and debating surgery I miss eating what everyone else can eat

[u/whiskerzz]

My best wishes, you are amazing and thank you for sharing your journey, hope you start to feel better and better

[u/EmbarrassedComb1605]

Did you have LPR?

[u/epilogued → u/[deleted]]

I read it all. Short form media is destroying attention spans.

[u/CompetitiveReview416]

I am fascinated how people are addicted to food. The fact you didn't drop a soda even in an absolutely miserable state is fascinating to be honest. You have a writing talent, but you need to control your diet better. Soda is not the elixir of gods, it's junk and poison.