Before BICORN

Starting at 30, I had 1-2 years of of regurgitation, heartburn, burping >100 times per day, difficulty breathing after every meal, epigastric pain, and constant anxiety, depression, and brain fog. These symptoms started right after I gained 10 lbs of bodyweight over my normal baseline weight.

Endoscopy revealed biopsy-proven H pylori gastritis but no hiatal hernia. I finished quadruple therapy and then took a breath test which came back negative for H pylori, but my symptoms didn't improve. On that day, the gastroenterologist was in a hurry to get me out of his office so he offered me antidepressants for my symptoms. I asked him about a hiatal hernia and he told me that he gave a talk about hiatal hernias once and was confident that it wasn't causing my symptoms. I Googled him later and found that he had no publications or conference presentations, and that he was probably just referring to a short lecture that he gave during his residency training in the hospital.

I was still suspicious so I got a CT which showed the world's smallest hiatal hernia (2 cm).

I wanted to see if I could manage it without surgery so I tried everything the internet said, including GERD medications, dietary changes, losing weight, those hand-massage exercises where you try to push the stomach down, and jumping on my heels after filling my stomach with a glass of water.

After a couple months of this regimen, nothing helped and the symptoms stayed the same. I knew that I could deal with GERD, pain, and burping, but what I couldn't live with was the anxiety, depression, and brainfog. My cognitive speed and ability to concentrate were afflicted, which was affecting my work and personal life.

So I knew my only option was to pick a procedure. My choices were surgical fundoplication, TIF (or cTIF), and the BICORN.

I didn't want a fundoplication because I was still young and healthy and the potential adverse effects were too much for me--I was already skinny and people with fundoplications are at risk of further weight loss. Also, I feel like fundoplications were only designed because American doctors are trained to treat obese patients who refuse to lose weight, not patients like me who are actually able to lose weight at will. Think about it -- They wrap the stomach around itself to stop it from moving upward. Why else would they do this if they didn't assume that the patient's amount of visceral fat surrounding the stomach would stay the same?

I didn't want a TIF or cTIF because they aren't performed by surgeons -- I had heard of cases whereby the endoscopist nicks branches of the gastric artery and causes patients to bleed.

I was willing to spend money and chose the BICORN.

Interestingly, I learned that the way the BICORN was developed was by simply performing a fundoplication without actually fundoplicating -- i.e. just attaching the top of the stomach to the esophagus without adding the extra twist. It was theorized to achieve the same effect as a fundoplication without actually reducing stomach volume, and thereby reducing the possible adverse effects.

After BICORN

The day after surgery, my anxiety, depression, regurgitation, heartburn, and difficulty breathing stopped. To this day, these symptoms are still gone. The only symptom I still have today is burping, but now I only burp < 20 times per day. The burping is likely due to chronic damage to the GE sphincter from the hernia. I'm overall very happy with the results and I feel pretty much normal despite the occasional burping.

Key Takeaways

1. DON'T EVER GET FAT. NOT EVEN 10 LBS OVER YOUR BASELINE WEIGHT. Even being slightly overweight can tear your tissues and create a hiatal hernia! I'm now very careful not to gain even a few lbs over my baseline weight so that I don't risk another hernia. This is especially important if you spend most of your day sitting down or if you like to lift heavy weights that tense your core muscles, because both of these activities will put pressure on your hiatus.
2. Very small hiatal hernias can often be very symptomatic despite what gastroenterologists will gaslight you into believing.
3. Anxiety, depression, and brain fog can be caused by the stomach pushing on the vagus nerve in a hiatal hernia. The vagus nerve normally courses through the hiatus alongside the esophagus. All my mental symptoms went away the day after the surgery. It was the biggest relief I had had in many months.
4. If you're overweight and decide to have any kind of surgery, then try to lose weight before your surgery, because your visceral fat is often the cause of your GERD symptoms and hiatal hernia in the first place. Some people experience a huge relief in symptoms just from losing weight. And even if weight loss doesn't relieve your symptoms, it's still important because it reduces the risk of recurrent symptoms after any surgery.

I hope this surgery becomes more popular and that it doesn't disappear. I worry that once the few surgeons who perform such operations will retire or pass away in the next 10-20 years, then there will be no one left in the world to do this kind of surgery and it will disappear forever. It has helped me a lot and I think it deserves more advocacy. Just my story. Other people's experiences may differ.