SleevedK

While it is indeed standard practice to repair hiatal hernias with a gastric sleeve operation, I don't think any doctor can guarantee you that your hiatal hernia will never come back. The things I've read indicate that the gastric sleeve seems to make your stomach MORE likely to herniate (since a sleeved stomach is narrower and therefore can slide up through the diaphragm hiatus more easily than a normal stomach). I know for a fact that there are some gastric sleeve patients who have had multiple hiatal hernia repairs after the surgery (and others who were told to convert to a bypass because of their hernias).

As far as the acid reflux issue, worse acid reflux is a known risk of the gastric sleeve. Some people are lucky and have no issues, but others do develop acid reflux for the first time after the sleeve or have much worse acid reflux after the sleeve. I would definitely ask him about why he thinks that this is not a concern in your situation and what his plan would be for how to deal with it if your acid reflux does get worse after the surgery. (If he tells you that you would just take a PPI for the acid if it gets worse after surgery, keep in mind that PPIs are not enough to control the acid for some people who have really bad acid reflux after the sleeve).

You are smart to be thinking about these issues before your surgery. Personally, I deal with both acid reflux and a hiatal hernia after the sleeve (and no I didn't have a hiatal hernia before the sleeve - they looked for it when they did the sleeve). Knowing what I know now, I never would have gotten the sleeve. I think the bypass has stood the test of time better than the sleeve has - after decades of experience with the bypass, surgeons know the risks of the bypass and are better at managing them, whereas problems with the sleeve are often handled by just converting over to the bypass anyway. Just look at all the stories on the revision forum about people converting from sleeve to bypass because of sleeve problems:
https://www.bariatricpal.com/forum/1302-revision-weight-loss-surgery-forums-new/

I am sorry that you have to go through another surgery but hope it helps your problems.
Unfortunately, I have come to realize that it seems EXTREMELY COMMON over the long term that Sleeve patients end up developing hernias and reflux. I suspect that, as we get more info about the long term with this surgery, it will become clear that something needs to change about the surgical technique to prevent this from being such a common complication down the road. Knowing what I know now, personally I wish I had never gotten the sleeve - if I had gotten bariatric surgery, I wish I had gotten the RNY instead. At least the RNY has been around long enough that the surgical technique has been perfected and we know a lot about how people do with it over the long run. I really regret that I didn't realize what I was getting myself into when I had the sleeve. You guessed it - I too have a hiatal hernia and reflux. People need to be aware that this is an extremely common scenario after a few years with the sleeve.

On 10/26/2021 at 8:08 AM, newsam1154 said:

 I agree 100%. I under went VSG in 2015 at the recommendation of my surgeon. I was initially looking into getting RNY but he stated since I was young and without children, it would be best to undergo the sleeve procedure. However, I'm 7 years post op, experience severe GERD, regained a good portion of my weight loss (my fault completely) and am now in the self pay bucket for revision as my current insurance under my employer outright refused any type of bariatric surgery.

I'm not saying all this to scare anyone, I'm just saying DO WHAT IS RIGHT FOR YOU. I wish I would have put my foot down on the decision between VSG vs RNY but all and all, I did it and it is what it is. It works for some, but not for all. Unfortunately I fell into the "not for all" and it was definitely USER error. I can't speak on it, but I feel I would have had a better success rate with RNY vs VSG which is why I'm looking into the self pay option for the revision surgery.

I would say to anyone looking into bariatric surgery to RESEARCH and ask a lot of questions at appointments/support groups. In the end like I said, do what is best for you. 😁

Sorry that you have had a hard time. I am especially sorry to hear you are struggling with the horrible post-sleeve acid reflux. That is one of the things I hate about the sleeve: that it is basically a huge gamble that you won't be one of the unlucky ones who has hellish acid reflux after the surgery.

If you are not able to get the RNY covered as a bariatric surgery, you may want to see if they can appeal it as being necessary for the acid reflux. After all, severe acid reflux is a health risk. We have had some threads here about other ideas on how to deal with the acid reflux, especially if you do in fact have a hiatal hernia :

Congratulations on almost being free of the lap band. I had a lap band for like 13 years and it caused me so much pain and misery over the years. Amazing how we put up with so much suffering because it starts to seem "normal".

I ended up going with a sleeve revision, but knowing what I know now, I would have either gone with the bypass instead or just tried to live with my normal stomach. The sleeve's tendency to cause reflux and hiatal hernias is a real problem. I didn't understand back then just how bad it could get.

15 hours ago, EllieV said:

Update! I appealed the denial, appeal was denied again, took the next step which was an external review from a 3rd party company, and they deemed the revision medically necessary so now my insurance is legally bound to uphold that decision and cover it 100%. It took a while, but I won!

More excited about winning the insurance battle than I even am about the surgery, but I know it will sink in soon.

Glad it worked out for you. Hope your revision surgery goes well. Please update us on how you are doing after it is over.

Call the surgeon's office. They will be able to tell you if it is concerning enough to go to the ER or if it can wait.

14 hours ago, MerelyMichelle said:

Hi.
looks like I’m the only one with regrets. Here’s my story.
I am 6 weeks VSG post op and 100% regret my decision.
Every single thing has been a struggle. I’ll elaborate.
The hospital stay was a living nightmare, I’m not getting help or support from my surgeon, soft watery foods hurt tremendously, I’m having a hard time getting 60g of Protein each day due to pain, and nausea, I’m having a hard time drinking enough Water because of nausea, and there are not enough hours in the day to get 60oz of Water AND 60g of Protein.< br /> here’s an example of what I’m talking about: I stop drinking water 30 minutes before any solid foods, in this case hummus. Using a baby spoon, I eat what’s on the very tip of the spoon. When I say it’s tiny, I mean it’s really tiny. I mix it with saliva, and swallow. I wait 5’ish minutes, and repeat. About 30-45 minutes of doing this I start getting a nasty pain in my left breast and along my left flank. I stop eating due to pain, not fullness or anything else. I’ve managed to consume approximately 1/2oz by that time, and give up because the pain is so bad. I wait 30 minutes and resume drinking water. I’ve read everyone is different so keep that in mind. 
 Ive tried this process with mashed potatoes, cream of wheat, yogurt, I’m sure I’m forgetting things but those are what I recall off the top of my head.
Anything thicker than watery applesauce hurts. Protein Shakes hurt too but my surgeon insets I push through the pain and nausea. He doesn’t seem to want to help with suggestions on what to try, he seems only interested in making sure his work isn’t the cause. He isn’t interested in helping me with the pain. I don’t want pain meds, I want him to engage, listen, and HELP. I have several complaints about him but I won’t go into detail here.

I think I’m dehydrated but like I said there aren’t enough hours in the day…I suppose I could stay up late to drink more water but then I’d have to extended that time to stop drinking before laying down otherwise I get reflux. I work and all of this is weighing on me at this point. My job performance is starting to suffer.

 Sorry for the book, and sorry for not having better news to report.
I sincerely hope you have a better experience.

I agree that this is not normal. I too have regrets about getting the sleeve, but what you are experiencing sounds like a fixable issue. I would try to seek a second opinion if your surgeon is not willing to help you get an endoscopy scheduled.

Just wanted to bump this thread to check on how both of you are doing. Kate, any update about getting your surgery date? Lee, are you still doing okay with your recovery?
My own plans for surgery were put on the back burner for a few reasons (some other family members with health issues that took priority, plus I felt like my symptoms had calmed down enough to be tolerable) but tonight I am having some terrible burning sensations that are making me think I need to do something sooner rather than later. It helps a lot to hear the experiences of others!

KateInMichigan, have you had your hernia repair surgery yet? I hope it went well if so. If you're still waiting, hope things move along soon!

On 8/18/2021 at 2:30 AM, sleeveinthecity said:

Hi there! I’m almost 8 months PO and am still being monitored. It has gotten a little better but not completely. I am learning to deal with it though I think 🙈

I am glad that it seems like it is getting better. I did find a paper talking about this kind of thing happening after bariatric surgery, so apparently you are NOT alone : https://pubmed.ncbi.nlm.nih.gov/32558689/

It actually seems like a fairly common problem, which I wish I had realized before I ever had surgery.

2 hours ago, Tracyringo said:

Do you remember which group? It would be so nice if I could find someone with this problem. I havent been able to find anyone that is having the issues I have.

Yes, the group is called "LINX Surgery for GERD/Acid Reflux/Silent Reflux/LPR". I believe you should be able to find it in the search on Facebook and request to join it. I have seen several people in the group who talked about how they had a gastric bypass to try to fix their acid problems, STILL had problems even after that, so then they got the Linx.

I am sorry that you are in this situation. It definitely sounds like you are really suffering, so I hope that the reversal helps you feel better. My situation is different than yours (I have a sleeve, which can't be reversed) but I definitely understand the feeling of regret for getting the surgery and wanting to go back to the way things were. The point of the surgery is to get healthier, not just to lose weight.
I would just want to make sure that the doctor has tried everything possible to help your symptoms with non-surgical treatments before getting the reversal, since it would be really lousy to go through all that and then find out the problems are still there.

7 minutes ago, Tracyringo said:

I have not seen him since the surgery. He doesnt believe its possible is my understanding but they still have not done the bravo test to find out anything and I am guessing it is not important with this Covid outbreak. I think I may go see my regular Dr. and see if she will order it because this PPI is 1000 bucks every 3 months and I shouldnt have to be taking one !

Ugh, I am sorry that you are still suffering with GERD after all that. Do you know if you might be a candidate for Linx? In one of the Linx groups on Facebook I saw that there were a few people who got Linx to control acid after a gastric bypass didn't work to stop it. The other thing I have read about is that sometimes people with the bypass end up with bile reflux from the intestines. The bile can cause a lot of throat irritation the same way that acid reflux can. I definitely think you deserve some additional testing to figure out why this is still happening after you have gone through so much.

On 8/2/2021 at 7:41 AM, EllieV said:

I am going on a year now trying to have a revision done due to GERD. Last August, I saw my old surgeon's nurse practitioner who told me that omeprazole daily was my only option. She ordered a swallow test which she reported looked "normal" and she could see no reason why I had GERD - so, again, continue with omeprazole. This past April, I finally had had enough and decided to advocate for myself a little more and saw a surgeon in another facility. He took one look at my swallow study and said it was far from normal - I have a huge dilated fundus and a hiatal hernia. He, too, tried to push the meds vs. a surgical intervention but I told him that I could not go on like this nor did I want to take yet another medication daily for the rest of my life for an issue that could be fixed with a revision. Fast forward to THIS August, I'm waiting on insurance approval with my fingers crossed. I'm frustrated that I was misdiagnosed, as this could've been taken care of almost a year ago... bottom line, push, advocate for yourself. You know your body best. The only trick is getting insurance to deem the revision medically necessary. Good luck!

Ugh, I am sorry that you were misdiagnosed for so long. I would definitely make a complaint at the first hospital so that hopefully the NP learns not to be so careless in the future.

I haven't had the enlarged fundus personally, but I have read about this happening to people after the sleeve. The "good" news about it is that it gives you additional options in how to treat the reflux. Most sleevers do not have enough fundus left for a fundoplication to control the acid to be an option, but since you have a larger fundus than normal, you probably can have at least a partial fundoplication (aka Toupet fundoplication). You may want to talk to a surgeon who does reflux surgery about that option if it is looking like they won't cover a revision to bypass.

4 years post-sleeve, yes, I do regret it. The sleeve has a pretty high rate of revisions to gastric bypass in the long run due to either really bad acid reflux or inadequate weight loss. It also makes you more likely to get a hiatal hernia post-operatively, which may not sound like a big deal, but it has had a real effect on my quality of life. I didn't have a hiatal hernia until after the sleeve.
Knowing what I know now, I would have never had bariatric surgery in the first place, because I was quite healthy in spite of being fat and bariatric surgery made my quality of life worse instead of better. However, if I did want to go through bariatric surgery, I'd rather get the RNY. At least the RNY has stood the test of time over many decades and cures acid reflux instead of making it worse like the sleeve does.
Personally, I would only recommend bariatric surgery to people who already have health issues from being fat. Then it is worth the risk that the surgery might create its own problems.

Hi. I just wanted to check in with you guys and see how you were doing with your motility issues. Did you end up having surgery for it?

I am sorry that you are so miserable. Unfortunately some people do get really bad reflux after the sleeve. Sometimes the shape of the sleeve just causes it.
Personally I have to take a combination of a PPI in the morning plus an H2 blocker at night to deal with my acid reflux. If it doesn't get better, you might need another surgery for it. Here are a couple of recent posts where we were discussing this issue of nasty post-sleeve reflux if any of the advice in the comments on that post is helpful to you.

Ugh, I am sorry that you are dealing with this problem. Rick's advice is solid. I suspect that he is correct that this nasty reflux is probably happening because you ended up developing a hiatal hernia. Hiatal hernias seem to be a VERY common complication of the sleeve long-term sadly, and reflux is the number one symptom they cause.
You will very likely be offered a revision to bypass, since that is the "tried and true" way of fixing this kind of problem. However, some people have had good results just repairing the hernia and not doing a whole revision.
If it does turn out you have a hernia, check out these recent discussions we have had about the issue:

On 7/14/2021 at 8:40 PM, KateinMichigan said:

In recent years I’ve noticed a spike in the “Hiatal Hernia Surprise surgery” stories shared on the forums. That’s when you wake up to your surgeon telling you he fixed a “surprise hernia” while doing your sleeve. What gives?

My 15 years of suffering with GERD after VGS, (I never ate a Tums before sleeve) has lead me to extensive research on this topic. I’ve read ever medical paper, report, blog I can get my hands on. I’ve met with and spoken to MANY surgeons on this subject.

THEORY ABOUT “THE SURPRISE”

I have a sneaking suspicion that the sleeve surgery itself leads to a hernia in many patients. (See stats about De Novo GERD and VGS).

The new stomach is lighter and thinner, with more internal pressure and can now easily slide into the esophageal area past the diaphragm to create a HH because the new shape allows it to.

I wonder if VSG surgeon don’t want to scare patients with the stats (30-40% chance of GERD without HH repair), so they just throw in the “hernia surgery surprise” to skirt the conversation.

if this happened to you, please share the details- so many would benefit from your story. Knowledge is power!

For those who haven’t had it yet - have the convo with your surgeon- let’s eliminate the “surprise”.

I’m also sharing my journey to find a solution for those currently suffering from GERD after VSG.

Not sure why post VLS GERD is still the “Wild West”. So many different opinions on how to fix it - sheesh.

What I’ve been told to do by different surgeons over the years, and what I’ve learned:

1) “convert to rny”

This was an instant turn off, but I get why so many do it. The pain is that bad for some.

A seasoned WL surgeon recently told me the conversion to RNY is problematic long term (yet many still recommend it). He doesn’t do it anymore. He’s fixed hundreds of these HH post sleeve with a basic HH repair, no- and only had to covert 1 stubborn case.

He said the conversion often leads to gas, malabsorption, vomiting, exhaustion, nausea, with many converts still ending up with GERD!

If you’ve had the conversion and are a few years out - please share your experience.

2) “go with a partial wrap”

This particular Doc said he’d “figure out what was best to do once he was in there.” I lost all confidence in him with that last statement, but I didn’t even realize this was a possibility if your fundus has expanded.

3) “get the LINX”

I’m allergic to fake metals (I get hives), yet this particular surgeon was ready to slap this metal puppy around my esophagus. Luckily, the maker ( J&J) posted a warning on their site for sensitive skin types: “do NOT, under any circumstances, put this in your body”.

I might have considered it if I didn’t have the allergy, although it seems very problematic for some.

4) “get the ligamentum procedure with repair”

This is an old surgery for GERD that involves using your internal umbilical cord. Because it’s so new for WLS GERD, I asked the surgeon if one of his success stories could call me. He obliged. A very sweet women called me, and went on and on about how great the surgeon was. But then she told me she was still on PPI’s and now had chronic diarrhea and dumping syndrome…sooo…back to the drawing board.

5) “Get the basic HH repair”.

I’ve consulted with 3 seasoned WLS surgeons who are all on the same page (finally). These 3 say that they pull my stomach back into the right spot, tighten the diaphragm, and call it a day. One uses mesh, but the other 2 sited a recent research paper saying there is no advantage to mesh.

They all said I’d have a 80-90% chance of being able to go off the PPI’s. Sorta a fantasy promise- but I’m liking those odds.

Of course I’ve done my research and discovered the fail rate over the long term is high (30-40%) after 10 years. and I might have minor swallowing problems, and bloating- yea! But I can have it adjusted if it gets bad, so that’s reassuring.

So I’m going in with my eyes wide opened and doing the basic repair, I hope it works. The recovery is long and difficult, but my alternative is PPI’s that are cancerous.

Wish me luck and thanks for reading my rant:) I hope it helped a few of my Gerdy sisters, and if you’ve had the “surprise”, please share your experience!

Thank you so much for the summary of what you heard from the surgeons. This is actually the first time that I have heard a surgeon has noticed a trend of long term problems from sleeves revising to RNY. Thank you for making me aware of this. Sometimes I have wondered if I should do the revision to RNY since it is supposed to be the most reliable fix to this issue (and so many doctors push it as the best solution), but I definitely do not want to create new problems for myself. The other thing that scares me about the RNY is: if it doesn't go well, then what do you do?!

Interesting that you got to talk to someone who had the ligamentum teres repair. Based on what I have learned in researching the Linx, I would wonder if her problems with diarrhea and dumping syndrome might mean that the ligamentum teres repair is pushing on her vagus nerve. The vagus nerve runs along the esophagus and stomach, and when the vagus nerve gets irritated, it can cause symptoms like that. I have seen people talk about how sometimes the Linx can cause vagus nerve issues, but never knew that could be a problem with the LT procedure too. Good to know.

I think that an 80-90% chance of getting off PPIs with just a basic hernia repair sounds amazing. Do you mind telling me who the surgeons who said that are? Even if the repair doesn't last forever, maybe if you can get a few years of relief, there will be a better solution later on down the road.

For me, the surgery wasn't worth it. I believe it is the reason that I ended up with a hiatal hernia (I didn't have one before the surgery) and I have some moderate GERD problems since the surgery (though my GERD is not as severe as the GERD that some unlucky people end up with after the sleeve). Looking back on it now, I wish I would have just avoided any bariatric surgery at all, but if I were still going to get surgery, I personally think that the gastric bypass would have been a better way to go actually. I chose the sleeve because I was scared of the bypass and didn't want to take the risks of the bypass, but the bypass at least is the "tried and true" method that has stood the test of time over decades. The sleeve has a pretty significant risk of ending up with severe GERD, and if you get severe GERD, many doctors will tell you to get a bypass to fix the GERD. Then you end up going through ANOTHER surgery, which is riskier than just getting the bypass to start.

On 7/14/2021 at 5:34 PM, KateinMichigan said:

Cont..

the new stomach is lighter and thinner, slides into the esophageal area because the new shape allows it to.

The seasoned docs now realize that the sleeve surgery actually causes this, so after they create the sleeve, they tighten the diaphragm so a hernia can’t slide up right away. (HH repair has a large fail rate).

why not be upfront about this? Why are so many waking up to the “hiatal hernia surprise!”

You are absolutely correct that the shape of the sleeve stomach makes developing a hiatal hernia more likely later on than with a normal stomach. That is exactly what one of the research articles I found talking about hiatal hernias after sleeve surgery said.
I think the issue with people being surprised by a hernia repair during sleeve surgery is that sometimes sliding hernias are not detectable on the testing before surgery and are only discovered once the surgeon is actually looking at the stomach during the operation. I had no hernia repair during my sleeve surgery (which was in Dec 2016). I really don't think I had a hernia until about December 2020 (when I first noticed some weird symptoms that at the time I didn't understand but now in retrospect believe were from the hernia).

Your surgery must be coming up soon, so best of luck. Please do update us on how it goes.

I am sorry that you have suffered so much. I think it is important for all of us to know what can go wrong with these surgeries so that hopefully people will know what kind of aftercare they need and to ask for help if things aren't going well before it gets out of control. I wish you the best on recovering from all of this!

On 6/28/2021 at 2:38 PM, KateinMichigan said:

You are a saint for keeping us updated! We are all rooting for you and I’m so glad to hear that it’s getting better! I’m assuming that there is no acid reflux - but without food to trigger it Im sure it must be an odd feeling. These updates are going to help so much when I have the surgery- now I know what to expected. I can’t wait until the day where you don’t have any diaphragm soreness and the day you have your first real meal!!!! Hang in there:)

I hope that your surgery goes well! I know you've been suffering with this awful problem for such a long time. I am excited for you that hopefully it will be fixed soon. Please do keep us updated on how you are doing!

On 6/28/2021 at 3:09 PM, leebick said:

Thanks for the support!!

I'm not eating a whole lot- pudding, Soup, Protein Shakes, cottage cheese, but not much else. Today I made chicken salad and pureed it. Gross... but it helps to have something different to eat, and so far I've had no acid issues. The weather isn't my friend right now. I live in north-central Maine, about a 4+ hour drive north of Boston, and we are having a heat wave! It's 92F outside with a heat index of 102F. The thermometer on my family room wall says 88F. Of course we don't have a/c in our home- hardly anyone does up here. I'm sitting with the fan blowing directly on me but it's so freaking hot!! I'm making my Protein shakes with Water and pouring them over ice so I get my fluids in. It's so hot I don't really want to eat much anyhow- although popsicles or fudgsicles sound pretty good right about now!

Thank you so much for sharing your experience here. I felt so alone when I first started to have issues with the hiatal hernia because it seems like you see so many stories about people getting hiatal hernias repaired when they get the sleeve, but not much about the people who have to deal with it after the sleeve. Hope that you are able to stay cool and that your recovery continues smoothly.