SleevedK

I saw this webpage for Dr. Elias Darido, who appears to be very knowledgeable about the sleeve and says that in many cases a hernia repair alone will stop the reflux. He will do virtual consults online. However, I have not yet found anyone who has actually seen him as a patient, so I don't actually know much about him.
https://houstonsleevesurgeon.com/category/acid-reflux-and-heartburn/

I also found out that Dr. Keshishian, who I know is pretty well known in the WLS world, has experience with repairing hernias after sleeves:
https://www.dssurgery.com/laparoscopic-hiatal-hernia-repair/

I am so glad that you mentioned that Dr. Jossart is experienced in dealing with this issue. I will need to look into that. Did you have to make an appointment with his office staff to talk to him?
I am sorry that you are suffering with these issues too, but I am also glad that you are here and talking about what you have learned. It is so nice to hear from someone else who is interested in this topic and taking action to try to figure it out. This is such a difficult problem because it seems like there aren't a ton of people who have dealt with it so you feel kind of alone struggling to find help with a complicated problem that even many doctors don't seem to understand very well. To be honest, I desperately wish that I had never had the sleeve, because I didn't understand at the time what trouble it could lead to, and I NEVER wanted a bypass under any circumstance. I wish I had made it more clear to my doctor at the time that I did not consider the bypass an option and maybe then she would not have done the sleeve.

Here are a couple of other leads that I have found that you might want to check into:

Dr. Kenneth J. Chang at UC Irvine is doing research into an experimental method of controlling GERD with an endoscopic procedure that can be done post-sleeve.
https://www.ucihealth.org/find-a-doctor/c/kenneth-chang
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133678/

Dr. Olaya I Brewer Gutierrez at Johns Hopkins is apparently close to starting a clinical trial using a similar endoscopic procedure:
https://clinicaltrials.gov/ct2/show/NCT04771247

1. Did you feel the same way? Yes, I was not totally sure about getting the sleeve, but I ignored my doubts and went through with it anyway.
 2. Are you glad you did it? No. I do regret it.
3. Do you have any regrets? Yes. I now have a hiatal hernia and GERD that affect my quality of life. The hiatal hernia came AFTER the sleeve - I didn't have one beforehand.
I didn't realize at the time that I had the sleeve that the shape of the sleeved stomach makes it prone to herniate, that if it does herniate that it can cause very significant symptoms even if it is a "small" hernia, and that permanently fixing a hiatal hernia after the gastric sleeve is not easy (hence many surgeons will tell you to just convert to a gastric bypass if you get a hernia after the sleeve).
 4. What’s one thing you wish someone had told you before you had surgery? I wish that someone had simply explained to me the problems that hiatal hernias can cause, that the gastric sleeve makes it much harder to surgically fix a hiatal hernia than it is if you still have your normal stomach, and that your quality of life can be ruined if you are one of the unlucky ones who has a lot of symptoms from it.
I wish someone had told me that there was a real risk that I might end up being forced into converting to a gastric bypass because the sleeve caused problems.

I know that pre-op people don't love hearing about regrets or the problems, but the truth is that I was better off before the surgery. Sure, I was fatter, but I was pretty healthy in spite of that and my weight was not affecting my quality of life.
I desperately wish I could go back in time and tell my surgeon not to do it. The surgery works for a lot of people, but some people are worse off after it. If you aren't SURE you want the surgery, and especially if you are not willing to accept the risk that you might end up with health issues that force you to convert to a gastric bypass later, then I would advise not rushing into it. Wait until you are sure.

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/

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/

Hey all, I'm back because I've developed severe GERD, esophagitis and a large hiatal hernia. I had an endoscopy this past Tuesday and they found my hiatal hernia was classified as large, several superficial ulcers, severe reflux/GERD. The esophagram I had a few weeks ago showed esophageal spasms and the results of the endoscopy indicate the spasms are due to the acid reflux. I frequently throw up my food due to the coughing triggered by the spasms. Fun times I tell ya! I saw my surgeon Wednesday and I was already thinking about hiatal hernia repair and asking about if she could do the RNY conversion at the same time. Well, she brought that up before I could. She gave me a few options and the repair and conversion is what I felt most comfortable with. She's having her prior authorization person working on the insurance part. I should hear something before Christmas. We're looking at a possible date of early to mid-January.

This is very interesting and is a current issue that I have been battling for two years to have covered by my insurance company.
I had lab-band done in 2013. Starting weight was 317 and got down to 222 pounds. However, I suffered from extreme acid reflux, causing me to sleep sitting up for three years. I was vomiting acid and sick every meal. When I spoke to my doctor about this, he immediately suggested conversion to VSG. While awaiting the approval for the VSG conversion, they made me do it in two parts. One surgery to remove the band, wait six months for the stomach to reshape itself, and then complete the VSG surgery. I gained 50 pounds back of my lost weight. I had the conversion done in December 2016. Everything went well. Acid was gone. However, I never felt restricted at all. I never really lost weight.
Fast forward one year to 2017, and the acid returned. In 2019, after having severe complications from acid reflux and developing a nightly cough, I called my doctor only to find out that he had passed away. I decided to see an upper GI doctor who did an EGD and found me with Hernia, GERD, and Esophagus damage. He sent me to a surgeon specializing in throat cancer and bariatric issues. Submitted to have surgery was denied.
We have been battling this for almost two years. I went this past week to another bariatric doctor familiar with my deceased doctor's work and also completed an EGD himself on me this past Monday. Same thing, Hernia, GERD, and now they believe I have Barretts Esophagus. They submitted to the insurance to repair and again denied. Insurance says these complications came from bariatric surgery and did not cover even if medically necessary; My new doctor is also a lawyer (go figure); he is completing a peer-to-peer next week to try to have them complete the repair one final time. If approved, I will only need to pay for the bypass conversion. So fingers crossed. I feel as if my insurance company would rather me die of esophagus cancer than keep me from dying from cancer. It is truly sad.

Sleeve and Lap Band operate under a high pressure system. It puts a lot of pressure on your esophageal sphincter. Some people with these surgeries develop issues with GERD and esophageal motility issues years after having their surgeries. Sure GERD will go away with weight loss, but after years of high pressure on the sphincter, GERD can manifest again.
I had a Lap Band for seven years and had it removed a year ago due to GERD and revising to RNY soon.

1. Did you feel the same way? Yes, I was not totally sure about getting the sleeve, but I ignored my doubts and went through with it anyway.
 2. Are you glad you did it? No. I do regret it.
3. Do you have any regrets? Yes. I now have a hiatal hernia and GERD that affect my quality of life. The hiatal hernia came AFTER the sleeve - I didn't have one beforehand.
I didn't realize at the time that I had the sleeve that the shape of the sleeved stomach makes it prone to herniate, that if it does herniate that it can cause very significant symptoms even if it is a "small" hernia, and that permanently fixing a hiatal hernia after the gastric sleeve is not easy (hence many surgeons will tell you to just convert to a gastric bypass if you get a hernia after the sleeve).
 4. What’s one thing you wish someone had told you before you had surgery? I wish that someone had simply explained to me the problems that hiatal hernias can cause, that the gastric sleeve makes it much harder to surgically fix a hiatal hernia than it is if you still have your normal stomach, and that your quality of life can be ruined if you are one of the unlucky ones who has a lot of symptoms from it.
I wish someone had told me that there was a real risk that I might end up being forced into converting to a gastric bypass because the sleeve caused problems.

I know that pre-op people don't love hearing about regrets or the problems, but the truth is that I was better off before the surgery. Sure, I was fatter, but I was pretty healthy in spite of that and my weight was not affecting my quality of life.
I desperately wish I could go back in time and tell my surgeon not to do it. The surgery works for a lot of people, but some people are worse off after it. If you aren't SURE you want the surgery, and especially if you are not willing to accept the risk that you might end up with health issues that force you to convert to a gastric bypass later, then I would advise not rushing into it. Wait until you are sure.

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

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. 😁

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.

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.

Why not contact surgeon?

Two and a half years out, I have no regrets at all. The process has its ups and downs, but at no time have I ever wished I didn't do it. I'm normal-sized for the first time since I was about eight years old. Things that used to be a struggle, I can do without thought now. I got stuck in a middle seat on a five-hour flight and I was REALLY dreading it. But when the time came, it was really no big deal. Sure, I'd rather have a window or aisle, but it wasn't the catastrophe it would have been when I was at my top weight. Because I had been heavy since childhood, I still find surprises every day as I learn to navigate the world in my new body. I even enjoy being able to walk into a room and not stand out because of my size. Maintenance is a learning curve for sure - sometimes I get too relaxed and gain five pounds and then I'll overcorrect and lose eight, LOL. But it's all good and I'm figuring it out.

It is unusual, and I would question how successful it would be for additional weight loss purposes for the same reason that I am skeptical about revisions in the other direction - VSG to RNY for weight loss. Metabolically, they are too similar to provide a major difference over the long term; short term one can expect some loss, typically 20 lb +/- some from the restrictive dieting required around surgery time (though a few outliers do report good results.) More common are RNY revisions to either tighten the stoma or resize the pouch, either directly or via a lapband, None of those procedures have a great record, either. The best results that I have seen with any consistency is to revise to a DS (duodenal switch) but that is a very complex surgery that few surgeons are qualified to do (though doing the DS from a VSG is quite straightforward for a qualified DS surgeon.)

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.

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.

Hi @MerelyMichelle. You may have a stricture. They occur because scar tissue forms & narrows your tummy. Symptoms include difficulties swallowing, nausea, vomiting, inability to eat certain foods, discomfort/pain. A simple endoscopy will discover if that is the cause of your problems & can be easily repaired endoscopically (balloon dilation).
Ask (demand) your surgeon explore this as a possible diagnosis. You shouldn’t be experiencing what you are.

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.
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.

Some sleevers need Vitamins long-term and some don't. I'm one of those that do, in fact I had a B12 scare recently. Somehow my B12 got low and I got the whole list of nasty symptoms (minus pale skin, for obvious reasons, LOL):
Weakness, tiredness, or lightheadedness
Heart palpitations and shortness of breath
Pale skin
A smooth, sore tongue
Constipation, diarrhea, loss of appetite, or gas
Nerve problems like numbness or tingling, muscle weakness, and problems walking
Vision loss
Mental problems like depression, memory loss, or behavioral changes
What caused me to know something was seriously wrong was the "problems walking" part. I fell three times in 10 days and it hit me that's not normal.
I had to increase the dose of B12 I am taking and I'm still not free from all the symptoms, although I'm better. So it's a roll of the dice - you could be off supplemental vitamins relatively early or you could need them longer.

@Jerald180 :
truth is you won’t know how you will fare after either surgery until you have the surgery.
you can read about all the possibilities or probabilities of outcomes, but u will never know if you will be part of the percentages that don't fall in the posted statistical range.
I had the sleeve, prior to surgery I understood that dumping was on the rare side for sleevers. Surprise! I dump. It may be rare, but I got it anyway (though the effects have lessened over the years)
re: vitamins: like @Arabesque, i stopped taking my Vitamins long ago (i think around the 1 year mark). All my labs have been satisfactory since (i’ve had about 5 since stopping). Im relatively fit and have tonnes of energy.
In my insignificant opinion, you will be served well by either, so long as you work your plan. So go with what YOU are comfortable doing with a surgeon who supports it.
P.S. My surgeon let me choose (between sleeve and RNY). I didn't have GERD, and he said he was comfortable doing either and that it was my body and i had to live with it, so i should decide what gets done to it.

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.

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 had a Sleeve Gastrectomy in 2017, I am now on my third revision operation and have been suffering over the last 2 years with horrendous GORD.
is anyone on here from Scotland and had surgery with Prof Bruce and experienced any issues with this surgery at all. Looking like I will need further revision and now full Gastric Bypass, it’s not looking good 🥲
just wondered if anyone on here from Aberdeen, Scotland with similar situation