KateinMichigan

Yep, I have GERD and a hiatal hernia. I am still trying to weigh the options on how to deal with it. Knowing what I know now, I wish I had never had bariatric surgery at all - in MY case, I think I would have been happier and healthier without surgery, because my weight wasn't causing me any health issues yet and I just gave myself new problems with the surgery. If I was in fact dealing with health issues from the weight, now I feel like I might have been better off just doing the gastric bypass from the start.

I had the sleeve in December with the hernia repair. Pre-surgery I didn’t get GERD bad, it was rare and only at night before bed. After surgery I feel like it might have got worse at the 2 month mark, but your surgeon most likely will give u medication and I’ve been taking it and it helps a lot- when I forget the acid reflux will remind you to. There’s one pill u can take before you eat to help- which Is very helpful to take if You plan on eating out. I hope it is just a temporary thing.

I had an esophageal manometry test (which I don't know the results for, will get next week when I see WLS surgeon), but regardless - I am in Canada. LINX is not approved for use here in Canada. I asked him at 3 months post-op where he told me LINX isn't approved, and that he thinks in 15 years - LINX will be the new gastric band story - lots of erosion etc. So, LINX isn't an option for me, really.
I'm going to explore alternative options with him to see what he thinks. I'll be bringing the Ligamentum Teres paper, and also the BARF paper showing hiatal hernia repair works for these symptoms too. It's not that I absolutely won't agree to getting RNY, but I really truly feel like RNY should be a last resort. Not the first-line response to non-PPI responsive GERD after sleeve.

Do you know if you are a candidate for Linx, JRL? That is an option for fixing the hernia and LES, *if* you have enough esophagus motility for it.
I would definitely talk to a surgeon who does Linx before I would agree to a bypass.

It is hard for me to accept the idea of being forced into a bypass when I really regret ever getting bariatric surgery to begin with. I feel like I am worse off this way than I would have been with my original stomach and the extra weight.

I wanted to preface this post with this optimistic fact. My husband had the surgery with amazing results and no problems whatsoever 15 years ago - it saved his life. He lost over 150 pounds and kept if off. He's gained and lost the same 25 pounds like your typical middle aged person, but it's been nothing but a blessing for him. We had different surgeons.
My experience wasn't so awesome, and I feel it's so important to share a few facts so you choose the RIGHT surgeon and ask the RIGHT questions. I hope I can help people avoid the avoidable. I'm a big believer in the surgery - but I want you to not suffer. Let me help:)
What's the problem?
The sleeve has a common and serious side effect that I suffer with, and that many surgeons downplay. GERD. But this isn't the GERD you think you know - I'll jump into that later. GERD has up to a 30% rate of occurrence after VSG - that's a lot higher then what my doc told me. https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.14467. Not only did my doctor gloss over it, and convey that it was "really rare", but he didn't really explain what this type of GERD is. I'm going to explain what this type of GERD is, and then I'm going to arm you with the right questions and research to do before you pick a surgeon. Because once it goes bad, your surgeon will pawn you off on a GERD doctor and that's that. Let me help you get proactive and avoid a bad result!
What is VSG GERD?
Gastroesophageal reflux disease, or chronic acid reflux is when acid shoots into your esophagus and throat. VSG GERD is different - that's why I'm giving it its own name. I never had GERD before the surgery. Now I get VSG GERD after drinking 4 oz. of Water. It's NOT triggered by food. This isn't occasional, it's constant without dangerous meds. I now weigh 115 pounds, so it's not triggered by overindulgence or weight gain brought on by binging.
Now you might think you already know GERD. Who hasn't had to pop a tums here and there? Not a bad trade off for a morbid obesity cure, right? THIS IS NOT THAT!!!! VSG GERD is an unrelenting tidal wave of persistent, burning acid that causes chest pain (and emergency room visits) that can only be somewhat managed by daily, longterm use of a class of drugs called PPI's. These PPI's lead to malabsorption and a host of side effects. I sit in my local cancer center to have my bi-annual 4-hour Iron infusion with chemo patients to name just one. https://journals.lww.com/ajg/Fulltext/2018/10001/Effect_of_Long_Term_Proton_Pump_Inhibitor_Use_on.1227.aspx
PPI's are a class of drugs that are only intended for 2 weeks of use because of their fairly horrific side effects. PPI's are linked to depression, blindness, cancer, and early death, (and this is the short list). There are several law firms dedicated to compensation for PPI victims. PPI's makes me feel like I've just downed a bottle of mayo. I've been nauseous for years. I alternate between taking a bottle of tums a day so that I can take breaks from the PPI - but I always revert back to them after a short break to alleviate the pain. I am seriously at risk for a ton of really serious diseases, and my liver tests are really bad. PPI's are deadly. I'm in the process of finding a surgeon who can help.
https://www.nature.com/articles/s41598-019-53622-3
The amount of VSG patients converting to the bypass/Linx system/etc. to rid themself of GERD and get off PPI's is exploding. Common sense would tell you that this isn't a" tums" sort of reflux!
Hope for post VSG GERD
As someone with no energy, horrible anemia, and low final weight - the bypass conversion sounds like a disaster because of the increased risk of malabsorption, but one surgeon told me it might be my only option. Some surgeons are discovering that a revision surgery to treat a hiatal hernial (HH) is the key to relief. I've had several scopes over the years, and they can never find a HH, but according to my husband's VSG surgeon, that isn't uncommon. He feels there is a possibility that my past the doctors missing it. I'm waiting on my barium swallow results. This gives me hope - that's why I wanted to share it. Hope is everything. I'm also going to talk with the doctor who wrote this article. "Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy". Follow me and I'll keep you updated. https://www.americanjournalofsurgery.com/article/S0002-9610(20)30814-X/fulltext#gr2
Future VSG patients - ASK QUESTIONS!
A few surgeons are now doing the sleeve with hiatal hernia repair at the same time, and some understand how important it is to consider GERD while doing the surgery. Different surgeons have different techniques. Some doctors "get it", and are being proactive because they've seen the pain that GERD causes. Some downplay it. I would suggest that ALL sleeve pre op patients have this discussion with their surgeon before moving forward. If he downplays it, RUN.
ASK!!!! Ask your surgeon how many patients has he had who've had GERD. How does/or will he address it if you are unlucky? Ask about his follow up - does he even know what's going on with his past patients? How does he keep track? Has he sent any patients to a GERD specialist? If he says, "oh, only a few of my patients had that" - ask him how he handled it. (My surgeon sent me to the GERD doc and then cut off ties. He was not curious about my results - he did not want to know. He probably still tells patients that it is rare. He has no idea I've been suffering for 14 years.)
Bariatric surgeons who've done the surgery and are on the forefront of GERD repair are a good bet. These doctors are rare and you need to really hunt for them.
If your doctor does the whole "very rare", etc. (my doctor did), he's either: not reading recent studies, not listening to his patients, not following up on them, minimizing this horrific side effect, or all of the above. Don't settle for a doctor who acts like it's "super rare" or "no big deal". THIS IS A BIG DEAL. Find one that is proactive and discusses HOW they avoid it.
I'm rooting for all of you! Let's get the surgery, but let's get it from the right people. Don't pick the guy in Mexico just because he's cheap. Don't pick the guy because he takes your insurance. Spend the money for a few consults to discuss the surgery with different surgeons. Come here and reach out to people who've gone to him/her. I went with a blind recommendation and didn't ask enough questions - and the price is really expensive - I'm still paying.

Me too! I've also spoken with Dr. Jossart in California who has done many hiatal hernia (HH) repairs post sleeve for those with GERD. This sounds perfect for you. He said he's done 125+ repairs with a 90% success rate. Only 1 of these patients out of over 125 needed a conversion to bypass.
As someone with no energy, horrible anemia (iron infusions) and low final weight - the bypass conversion sounds like a disaster waiting to happen, so I'm praying for a HH to show up on my latest swallow test. I've had several scopes over the years, and they can never find a HH, but according to Dr. Jossart that isn't uncommon, and he feels there is a very high likelihood that it's small and the doctor's I've seen are missing it. This gives me hope - that's why I wanted to share it. Hope is everything.
I also feel I should share that new research on PPI's show that they are now linked to depression (PPI's rank #1 as OTC drug that causes depression) and eye problems (including blindness). This is new research coming out to add to the list of problems it causes. We all need to get off PPI's!
Lastly, a few surgeons are now doing the sleeve with HH repair first, and with other GERD preventative measures DURING surgery. These doctors "get it", and are being proactive because they've seen the pain that GERD causes. I would suggest that ALL sleeve pre op patients have this discussion with their surgeon before moving forward, if he downplays it, RUN. If you are in the 30% that suffer, it's severely lowers your quality of life. I've been suffering for 14 years with too many dead end Dr. Appointments to count. Stanford, UofM - I've consulted with the best "experts" over the years and found found many shake their heads with a sort of "you're on your own" attitude.
I truly believe that the only hope we have is with a bariatric surgeon who really understands what was done and who has done the surgery - but also does GERD repairs. These doctors are rare and you need to really hunt for them.
When most hear "acid reflux" as a potential side effect, they think "so what, I'll have to take a tums once in a while". It's NOT that sort of reflux. It's debilitating. It's vomiting after half a cup of Water. It's pain after every single meal. It's instant dependency of horrific drugs with a myriad of side effects - including blindness and cancer. If my doctor had told me I had a 30% chance of this version of GERD, I would have run for the hills.
If your doctor does the whole "very rare", etc. (my doctor did), he's either: not reading recent studies, not listening to his patients, not following up on them (my doctor just pawned me off to a GERD doctor), minimizing this horrific side effect, or all of the above. Don't settle of a doctor who acts like it's super rare or no big deal. Find one that is proactive and discusses HOW they avoid it.
Please share with me all your research. I'm rooting for you!

Don’t worry about the weight, it’ll happen. And the slow eating will be second nature after a while. The fluids thing is very important - sounds like you are off to a fantastic start!

OH! No, he did have me take one for the 2 weeks I was on the antibiotics but none prior to that and none after.

My surgery was 8 weeks ago today.

How long ago was your surgery? Do you have any avid reflux?

Sounds great! How long ago was your surgery?

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

Me too! I've also spoken with Dr. Jossart in California who has done many hiatal hernia (HH) repairs post sleeve for those with GERD. This sounds perfect for you. He said he's done 125+ repairs with a 90% success rate. Only 1 of these patients out of over 125 needed a conversion to bypass.
As someone with no energy, horrible anemia (iron infusions) and low final weight - the bypass conversion sounds like a disaster waiting to happen, so I'm praying for a HH to show up on my latest swallow test. I've had several scopes over the years, and they can never find a HH, but according to Dr. Jossart that isn't uncommon, and he feels there is a very high likelihood that it's small and the doctor's I've seen are missing it. This gives me hope - that's why I wanted to share it. Hope is everything.
I also feel I should share that new research on PPI's show that they are now linked to depression (PPI's rank #1 as OTC drug that causes depression) and eye problems (including blindness). This is new research coming out to add to the list of problems it causes. We all need to get off PPI's!
Lastly, a few surgeons are now doing the sleeve with HH repair first, and with other GERD preventative measures DURING surgery. These doctors "get it", and are being proactive because they've seen the pain that GERD causes. I would suggest that ALL sleeve pre op patients have this discussion with their surgeon before moving forward, if he downplays it, RUN. If you are in the 30% that suffer, it's severely lowers your quality of life. I've been suffering for 14 years with too many dead end Dr. Appointments to count. Stanford, UofM - I've consulted with the best "experts" over the years and found found many shake their heads with a sort of "you're on your own" attitude.
I truly believe that the only hope we have is with a bariatric surgeon who really understands what was done and who has done the surgery - but also does GERD repairs. These doctors are rare and you need to really hunt for them.
When most hear "acid reflux" as a potential side effect, they think "so what, I'll have to take a tums once in a while". It's NOT that sort of reflux. It's debilitating. It's vomiting after half a cup of Water. It's pain after every single meal. It's instant dependency of horrific drugs with a myriad of side effects - including blindness and cancer. If my doctor had told me I had a 30% chance of this version of GERD, I would have run for the hills.
If your doctor does the whole "very rare", etc. (my doctor did), he's either: not reading recent studies, not listening to his patients, not following up on them (my doctor just pawned me off to a GERD doctor), minimizing this horrific side effect, or all of the above. Don't settle of a doctor who acts like it's super rare or no big deal. Find one that is proactive and discusses HOW they avoid it.
Please share with me all your research. I'm rooting for you!

He also mentioned medications and other non-surgical treatment options if it gets worse. I was surprised he recommended it too based on how all my research said not to do the sleeve if you have reflux problems. Idk, I’ll get a second opinion for sure

I Had my sleeve surgery on nov 23 2020 and I have GERD. my doctor doesn’t understand what I’m going through. He only told me to take gaviscon which didn’t help at all because every time I take it I throw it up in like half an hour. the reason why he doesn’t understand me it’s because I’m only 17 and he thinks I’m overreacting. It’s been 2 months now and my GERD is not getting any better. i throw up almost anything I eat or drink everyday. I used to be on Nexium 40 2x a day but it turns out I’m allergic to one of the ingredients. I really need help because it came to the point where I literally fast everyday.

First of all Merry Christmas.
I never had GERD or stomach issues before the sleeve. I have had 2 endoscopies and I have non-healing ulcerated stricture of the esophagus which was caused from the GERD thus the 2 pantoprazole a day.
I now weigh 163, I forgot how to change my weight and ticker, and I did it by Intermittent Fasting - I eat only with in 8 hrs a day. I'm amazed how well it works and I do low carb. My goal is 142 lbs so 21 to go and I'm doing it by intermittent fasting. Lots of FB groups for it and info out there.

Research the good and the bad of surgery. I would also suggest before surgery trying IF and low carb. I don't know how much you have to loose, your age or health but with surgery there is no going back. Truthfully if I had to do it over again I wouldn't of had surgery. In truth I wanted an easy and fast fix. Surgery is not it. I have had to take stool softeners since surgery due to Constipation. One good thing it did was normalize my BP which was only a little high.
I hope I've helped you a little with your choice and please remember there is no going back after surgery so research all you can and the Dr doing the surgery plays a big part.

I've had the sleeve for 6 yrs and I have had gerd since day 1. My Dr never told me this was a side effect of sleeve. I am now on pantoprazole 2x a day and have had 2 endoscopies because of the gerd. If I had to do it over again I would of done intermittent fasting and very low carb to carnivore and not done surgery. I only lost 25 lbs and am doing IF to get the rest off.

There's a really interesting paper published on this topic, it is currently in press. I can send you the full paper PDF if you'd like. You can see abstract etc here: https://pubmed.ncbi.nlm.nih.gov/33483233/
I have been having "BARF Syndrome" as they describe in the paper, and my 1-month post-sleeve barium swallow showed a recurrence of my hiatal hernia (it was repaired during sleeve). My surgeon also wants to convert to bypass.

This paper shows improvement of symptoms with even just HH repair.

I wanted to preface this post with this optimistic fact. My husband had the surgery with amazing results and no problems whatsoever 15 years ago - it saved his life. He lost over 150 pounds and kept if off. He's gained and lost the same 25 pounds like your typical middle aged person, but it's been nothing but a blessing for him. We had different surgeons.
My experience wasn't so awesome, and I feel it's so important to share a few facts so you choose the RIGHT surgeon and ask the RIGHT questions. I hope I can help people avoid the avoidable. I'm a big believer in the surgery - but I want you to not suffer. Let me help:)
What's the problem?
The sleeve has a common and serious side effect that I suffer with, and that many surgeons downplay. GERD. But this isn't the GERD you think you know - I'll jump into that later. GERD has up to a 30% rate of occurrence after VSG - that's a lot higher then what my doc told me. https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.14467. Not only did my doctor gloss over it, and convey that it was "really rare", but he didn't really explain what this type of GERD is. I'm going to explain what this type of GERD is, and then I'm going to arm you with the right questions and research to do before you pick a surgeon. Because once it goes bad, your surgeon will pawn you off on a GERD doctor and that's that. Let me help you get proactive and avoid a bad result!
What is VSG GERD?
Gastroesophageal reflux disease, or chronic acid reflux is when acid shoots into your esophagus and throat. VSG GERD is different - that's why I'm giving it its own name. I never had GERD before the surgery. Now I get VSG GERD after drinking 4 oz. of Water. It's NOT triggered by food. This isn't occasional, it's constant without dangerous meds. I now weigh 115 pounds, so it's not triggered by overindulgence or weight gain brought on by binging.
Now you might think you already know GERD. Who hasn't had to pop a tums here and there? Not a bad trade off for a morbid obesity cure, right? THIS IS NOT THAT!!!! VSG GERD is an unrelenting tidal wave of persistent, burning acid that causes chest pain (and emergency room visits) that can only be somewhat managed by daily, longterm use of a class of drugs called PPI's. These PPI's lead to malabsorption and a host of side effects. I sit in my local cancer center to have my bi-annual 4-hour Iron infusion with chemo patients to name just one. https://journals.lww.com/ajg/Fulltext/2018/10001/Effect_of_Long_Term_Proton_Pump_Inhibitor_Use_on.1227.aspx
PPI's are a class of drugs that are only intended for 2 weeks of use because of their fairly horrific side effects. PPI's are linked to depression, blindness, cancer, and early death, (and this is the short list). There are several law firms dedicated to compensation for PPI victims. PPI's makes me feel like I've just downed a bottle of mayo. I've been nauseous for years. I alternate between taking a bottle of tums a day so that I can take breaks from the PPI - but I always revert back to them after a short break to alleviate the pain. I am seriously at risk for a ton of really serious diseases, and my liver tests are really bad. PPI's are deadly. I'm in the process of finding a surgeon who can help.
https://www.nature.com/articles/s41598-019-53622-3
The amount of VSG patients converting to the bypass/Linx system/etc. to rid themself of GERD and get off PPI's is exploding. Common sense would tell you that this isn't a" tums" sort of reflux!
Hope for post VSG GERD
As someone with no energy, horrible anemia, and low final weight - the bypass conversion sounds like a disaster because of the increased risk of malabsorption, but one surgeon told me it might be my only option. Some surgeons are discovering that a revision surgery to treat a hiatal hernial (HH) is the key to relief. I've had several scopes over the years, and they can never find a HH, but according to my husband's VSG surgeon, that isn't uncommon. He feels there is a possibility that my past the doctors missing it. I'm waiting on my barium swallow results. This gives me hope - that's why I wanted to share it. Hope is everything. I'm also going to talk with the doctor who wrote this article. "Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy". Follow me and I'll keep you updated. https://www.americanjournalofsurgery.com/article/S0002-9610(20)30814-X/fulltext#gr2
Future VSG patients - ASK QUESTIONS!
A few surgeons are now doing the sleeve with hiatal hernia repair at the same time, and some understand how important it is to consider GERD while doing the surgery. Different surgeons have different techniques. Some doctors "get it", and are being proactive because they've seen the pain that GERD causes. Some downplay it. I would suggest that ALL sleeve pre op patients have this discussion with their surgeon before moving forward. If he downplays it, RUN.
ASK!!!! Ask your surgeon how many patients has he had who've had GERD. How does/or will he address it if you are unlucky? Ask about his follow up - does he even know what's going on with his past patients? How does he keep track? Has he sent any patients to a GERD specialist? If he says, "oh, only a few of my patients had that" - ask him how he handled it. (My surgeon sent me to the GERD doc and then cut off ties. He was not curious about my results - he did not want to know. He probably still tells patients that it is rare. He has no idea I've been suffering for 14 years.)
Bariatric surgeons who've done the surgery and are on the forefront of GERD repair are a good bet. These doctors are rare and you need to really hunt for them.
If your doctor does the whole "very rare", etc. (my doctor did), he's either: not reading recent studies, not listening to his patients, not following up on them, minimizing this horrific side effect, or all of the above. Don't settle for a doctor who acts like it's "super rare" or "no big deal". THIS IS A BIG DEAL. Find one that is proactive and discusses HOW they avoid it.
I'm rooting for all of you! Let's get the surgery, but let's get it from the right people. Don't pick the guy in Mexico just because he's cheap. Don't pick the guy because he takes your insurance. Spend the money for a few consults to discuss the surgery with different surgeons. Come here and reach out to people who've gone to him/her. I went with a blind recommendation and didn't ask enough questions - and the price is really expensive - I'm still paying.

My doctor repaired a hiatial hernia while doing my sleeve. I didn't even know I had one! But I will say, I have not had heartburn once since surgery

Sent from my SM-N981U using BariatricPal mobile app

As a recent sleeve to bypass patient - specifically to resolve the terrible GERD, Gastritis and Esophagitis caused by chronic acid reflux - I can so relate to your comments. I had acid reflux disease before I even had the sleeve, and my surgeon never told me that GERD could be a complication following sleeve surgery. In all fairness, I think that this has really only come to the surface over the past 5 years. Now surgeons, and GI doctors, seem to be more versed in GERD following sleeve surgery and more prone to advise patients to choose the bypass.
On a positive note, I've had ZERO acid reflux since my bypass surgery October 2020. I stopped taking any PPI, and my primary care doctor is thrilled. Long term use of PPI's can also lead to bone loss in women. Best decision I made was choosing the revision surgery.

Wow. I’m so sorry you went through that but thanks for sharing your story to helP others. I had No idea it was different than ordinary heartburn when I had the surgery.

Wow thanks so much for sharing your story. I had a small hernia that was discovered in preop testing. I wish I would have asked those questions or really ANY questions. I'm one month out of surgery lost about 45 pounds but feel terrible most days. Always tired and always hungry. Only had some wicked heart burn a few nights ago I just chalked it up to me moving from the pureed stage to solids. I so hope it gets better over time. I just figured I'm having a really slow recovery. Been taking famotidine for heart burn. It also happens if I dont eat anything. I will definitely bring more questions to my surgeon next visit.

Sent from my SM-G950U using BariatricPal mobile app

Great questions for your surgeon! Also, really great advice to look for surgeons with excellent credentials, excellent reputation, who can give examples of how they manage patients who develop GERD. It is an extremely important topic to research and ask good questions about....and also important that your surgeon has realistic good answers that gel with research. It is a common problem that sleeve patients need to take seriously.
Questions for surgeon... What steps do you take to prevent GERD? What strategies do you recommend for people who develop it? What percentage of your patients develop it? What do you do for them? Have you done continuing education on GERD management for sleeve patients? How has your approach to GERD changed in the years you've been doing sleeve surgeries?
I think this is a serious problem, and one I gave a lot of thought to.
That said....
I had a huge hiatal hernia before surgery, and terrible acid reflux.
My surgeon fixed the hernia when he did my sleeve and I have not had any acid since. Nada. Not one day...and it's been such a relief. Have often said that finding that rotten hernia and fixing it was one of the best things that ever happened to me. I'd have never looked for it if not for the sleeve surgery.
Experiences do vary...bigtime.
I appreciate your experience and think it's something folks need to be aware. Thank you so much for sharing it.

I wanted to preface this post with this optimistic fact. My husband had the surgery with amazing results and no problems whatsoever 15 years ago - it saved his life. He lost over 150 pounds and kept if off. He's gained and lost the same 25 pounds like your typical middle aged person, but it's been nothing but a blessing for him. We had different surgeons.
My experience wasn't so awesome, and I feel it's so important to share a few facts so you choose the RIGHT surgeon and ask the RIGHT questions. I hope I can help people avoid the avoidable. I'm a big believer in the surgery - but I want you to not suffer. Let me help:)
What's the problem?
The sleeve has a common and serious side effect that I suffer with, and that many surgeons downplay. GERD. But this isn't the GERD you think you know - I'll jump into that later. GERD has up to a 30% rate of occurrence after VSG - that's a lot higher then what my doc told me. https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.14467. Not only did my doctor gloss over it, and convey that it was "really rare", but he didn't really explain what this type of GERD is. I'm going to explain what this type of GERD is, and then I'm going to arm you with the right questions and research to do before you pick a surgeon. Because once it goes bad, your surgeon will pawn you off on a GERD doctor and that's that. Let me help you get proactive and avoid a bad result!
What is VSG GERD?
Gastroesophageal reflux disease, or chronic acid reflux is when acid shoots into your esophagus and throat. VSG GERD is different - that's why I'm giving it its own name. I never had GERD before the surgery. Now I get VSG GERD after drinking 4 oz. of Water. It's NOT triggered by food. This isn't occasional, it's constant without dangerous meds. I now weigh 115 pounds, so it's not triggered by overindulgence or weight gain brought on by binging.
Now you might think you already know GERD. Who hasn't had to pop a tums here and there? Not a bad trade off for a morbid obesity cure, right? THIS IS NOT THAT!!!! VSG GERD is an unrelenting tidal wave of persistent, burning acid that causes chest pain (and emergency room visits) that can only be somewhat managed by daily, longterm use of a class of drugs called PPI's. These PPI's lead to malabsorption and a host of side effects. I sit in my local cancer center to have my bi-annual 4-hour Iron infusion with chemo patients to name just one. https://journals.lww.com/ajg/Fulltext/2018/10001/Effect_of_Long_Term_Proton_Pump_Inhibitor_Use_on.1227.aspx
PPI's are a class of drugs that are only intended for 2 weeks of use because of their fairly horrific side effects. PPI's are linked to depression, blindness, cancer, and early death, (and this is the short list). There are several law firms dedicated to compensation for PPI victims. PPI's makes me feel like I've just downed a bottle of mayo. I've been nauseous for years. I alternate between taking a bottle of tums a day so that I can take breaks from the PPI - but I always revert back to them after a short break to alleviate the pain. I am seriously at risk for a ton of really serious diseases, and my liver tests are really bad. PPI's are deadly. I'm in the process of finding a surgeon who can help.
https://www.nature.com/articles/s41598-019-53622-3
The amount of VSG patients converting to the bypass/Linx system/etc. to rid themself of GERD and get off PPI's is exploding. Common sense would tell you that this isn't a" tums" sort of reflux!
Hope for post VSG GERD
As someone with no energy, horrible anemia, and low final weight - the bypass conversion sounds like a disaster because of the increased risk of malabsorption, but one surgeon told me it might be my only option. Some surgeons are discovering that a revision surgery to treat a hiatal hernial (HH) is the key to relief. I've had several scopes over the years, and they can never find a HH, but according to my husband's VSG surgeon, that isn't uncommon. He feels there is a possibility that my past the doctors missing it. I'm waiting on my barium swallow results. This gives me hope - that's why I wanted to share it. Hope is everything. I'm also going to talk with the doctor who wrote this article. "Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy". Follow me and I'll keep you updated. https://www.americanjournalofsurgery.com/article/S0002-9610(20)30814-X/fulltext#gr2
Future VSG patients - ASK QUESTIONS!
A few surgeons are now doing the sleeve with hiatal hernia repair at the same time, and some understand how important it is to consider GERD while doing the surgery. Different surgeons have different techniques. Some doctors "get it", and are being proactive because they've seen the pain that GERD causes. Some downplay it. I would suggest that ALL sleeve pre op patients have this discussion with their surgeon before moving forward. If he downplays it, RUN.
ASK!!!! Ask your surgeon how many patients has he had who've had GERD. How does/or will he address it if you are unlucky? Ask about his follow up - does he even know what's going on with his past patients? How does he keep track? Has he sent any patients to a GERD specialist? If he says, "oh, only a few of my patients had that" - ask him how he handled it. (My surgeon sent me to the GERD doc and then cut off ties. He was not curious about my results - he did not want to know. He probably still tells patients that it is rare. He has no idea I've been suffering for 14 years.)
Bariatric surgeons who've done the surgery and are on the forefront of GERD repair are a good bet. These doctors are rare and you need to really hunt for them.
If your doctor does the whole "very rare", etc. (my doctor did), he's either: not reading recent studies, not listening to his patients, not following up on them, minimizing this horrific side effect, or all of the above. Don't settle for a doctor who acts like it's "super rare" or "no big deal". THIS IS A BIG DEAL. Find one that is proactive and discusses HOW they avoid it.
I'm rooting for all of you! Let's get the surgery, but let's get it from the right people. Don't pick the guy in Mexico just because he's cheap. Don't pick the guy because he takes your insurance. Spend the money for a few consults to discuss the surgery with different surgeons. Come here and reach out to people who've gone to him/her. I went with a blind recommendation and didn't ask enough questions - and the price is really expensive - I'm still paying.