Loose Wrap with Poor Motility?

Hi Howard,

I saw my surgeon today to discuss my 24 hr pH and manometry results
(no impedance testing is done here). My 24 hr pH makes me an excellent
candidate for surgery, I have more than double the 'normal' amount of
reflux (9% upright and 3% recumbent), I had 117 reflux episodes, and
had excellent correlation between symptoms and actual acid reflux.
However, my motility study indicates a motility disorder, there is
almost a complete absence of peristalsis through the body of the
esophagus, and what is there is not synchronized. I had one normal
swallow out of the whole test. The LES pressure is 30mmHg and relaxes
appropriately during swallowing (I was told this is why I am
eventually able to pass food that does get stuck).

The surgeon wants to do a 'loose wrap' but he said there's a 50/50
chance that I could get worse after surgery in terms of swallowing,
and he said there's no way of knowing beforehand which way it will go.
This surgeon is very aggressive, and does very tight wraps normally.
Is there any point in getting a 'loose wrap' done? He didn't call it a
partial fundo. When I asked him how effective a loose wrap would be,
he didn't answer me. He said he would be more enthusiastic if I didn't
have motility problems but he still wanted me to have the surgery
done. I said no, for now, as I'm just not willing to have more trouble
swallowing. Is there a time when I should consider it? Right now I'm
well controlled on meds, would it be worth the risk if the meds stop
working?

I'm also wondering if it's true that motility problems caused by acid
reflux are evident as 'rings' on an EGD. The nurse told me that my
motility disorder is not caused by acid reflux because I had a normal
EGD. Is that true? The surgeon thinks my motility 'might' get better
post-op because I have more trouble swallowing off meds than I do on
them.

Thanks!!

Amy
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przyjaciel (06.02.2008 04:25)