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.

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.

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.

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!

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.

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.

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.

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.