VSG & reflux

[fiera121 0]

I need advice. I have gone thru the entire four-month process and am just days away from my sleeve surgery (just waiting for approval from the insurance company). However, I'm so worried by something that I am having trouble sleeping, unable to reach a decision. Like most of us, I have two choices for my surgery: RNY or VSG. I also have two medical problems; one is an issue with the RNY & the other is an issue with the VSG.<br /><br />I chose the VSG over the RNY for several reasons, the main two being I don't like the idea of having my intestines rearranged when the VSG works just as well & has less risks, and the other being because I have a back condition that causes me to take NSAIDs daily. I have a bulging disc & arthritis in my lower back, and also heel spurs. I take Naprelan 750mg every day and without it, walking and standing is very painful. This alone is enough reason to want the VSG over the RNY.<br /><br />However, I also have severe acid reflux. I do not have heartburn symptoms. Instead, when I have a reflux attack, I can't stop clearing my throat; it will last about an hour and is very unpleasant. When I take Nexium daily, that goes away - not a problem. However, whenever I get a cold or have allergies, I get a cough that lasts 3-4 months; 4 doctors have now told me that the chronic cough is due to acid reflux (the acid irritates my trachea or something). I had an endoscopy and they diagnosed a hiatial hernia. Then I had an Upper GI and they found no hernia, just severe reflux, esophageal spasms & rapid gastric emptying. So I don't know if I have a hiatial hernia or not; the tests showed different results and I don't know which is right.<br /><br />Here is my problem. My surgeon recommends the RNY for me, because of the reflux, which he says will probably get worse after a VSG. I pretty much decided against the RNY long ago because I don't want to give up my NSAIDs. The doctor says I can still take NSAIDs after a bypass, just in smaller doses and infrequently, but that goes against everything I've read and I'm not comfortable with it. Besides, I need them daily and small doses don't help me. I know losing weight will help my back, but I don't know how much it will help, and I'm not willing to take the gamble and live in constant pain because I can't take my antiinflammatory meds. (Not to mention that my back is getting steadily worse.)<br /><br />Which leaves me with the VSG, which is what I really want anyway. But I am very worried about the reflux. At this point, I don't know if I have a hiatial hernia. If I do, then the doc will repair it and it should be okay. But if I don't, am I condemning myself to a lifetime of chronic coughing (not to mention possible ulcers & esophagael cancer) due to uncontrolled reflux?<br /><br />Has anyone else gotten conflicting information (endoscopy vs upper GI) about whether or not they had a hiatial hernia? If so, which test was right?<br /><br />And if I don't have the hernia and go ahead with the sleeve surgery, what will happen with my reflux? Will it be permanent, or likely to go away when I lose weight? I don't mind taking meds the rest of my life, but I don't want this horrid cough forever. :-(<br /><br />Sorry this is so long, but it's a life-changing decision I'm facing and wanted to be sure I told the whole story. Any help would be greatly appreciated!

[smkeller 3]

Fiera121, I had the VSG a month ago. I was on one Omaprezole per day before the surgery and I am on one after surgery. But if I forget to take it, watch out! Especially bad if I am sleeping. Sometimes I take another, because my stomach is starting to get feisty. I also was taking two 200mg Celebrex per day. Since the surgery I have not had to take the Celebrex, but I am not sure why. I just don't seem to have the same level of pain. Whether this is temporary or permanent I can't say. Good luck on your choice and your surgery. These are the most trying days of the process.

I need advice. I have gone thru the entire four-month process and am just days away from my sleeve surgery (just waiting for approval from the insurance company). However, I'm so worried by something that I am having trouble sleeping, unable to reach a decision. Like most of us, I have two choices for my surgery: RNY or VSG. I also have two medical problems; one is an issue with the RNY & the other is an issue with the VSG.<br /><br />I chose the VSG over the RNY for several reasons, the main two being I don't like the idea of having my intestines rearranged when the VSG works just as well & has less risks, and the other being because I have a back condition that causes me to take NSAIDs daily. I have a bulging disc & arthritis in my lower back, and also heel spurs. I take Naprelan 750mg every day and without it, walking and standing is very painful. This alone is enough reason to want the VSG over the RNY.<br /><br />However, I also have severe acid reflux. I do not have heartburn symptoms. Instead, when I have a reflux attack, I can't stop clearing my throat; it will last about an hour and is very unpleasant. When I take Nexium daily, that goes away - not a problem. However, whenever I get a cold or have allergies, I get a cough that lasts 3-4 months; 4 doctors have now told me that the chronic cough is due to acid reflux (the acid irritates my trachea or something). I had an endoscopy and they diagnosed a hiatial hernia. Then I had an Upper GI and they found no hernia, just severe reflux, esophageal spasms & rapid gastric emptying. So I don't know if I have a hiatial hernia or not; the tests showed different results and I don't know which is right.<br /><br />Here is my problem. My surgeon recommends the RNY for me, because of the reflux, which he says will probably get worse after a VSG. I pretty much decided against the RNY long ago because I don't want to give up my NSAIDs. The doctor says I can still take NSAIDs after a bypass, just in smaller doses and infrequently, but that goes against everything I've read and I'm not comfortable with it. Besides, I need them daily and small doses don't help me. I know losing weight will help my back, but I don't know how much it will help, and I'm not willing to take the gamble and live in constant pain because I can't take my antiinflammatory meds. (Not to mention that my back is getting steadily worse.)<br /><br />Which leaves me with the VSG, which is what I really want anyway. But I am very worried about the reflux. At this point, I don't know if I have a hiatial hernia. If I do, then the doc will repair it and it should be okay. But if I don't, am I condemning myself to a lifetime of chronic coughing (not to mention possible ulcers & esophagael cancer) due to uncontrolled reflux?<br /><br />Has anyone else gotten conflicting information (endoscopy vs upper GI) about whether or not they had a hiatial hernia? If so, which test was right?<br /><br />And if I don't have the hernia and go ahead with the sleeve surgery, what will happen with my reflux? Will it be permanent, or likely to go away when I lose weight? I don't mind taking meds the rest of my life, but I don't want this horrid cough forever. :-(<br /><br />Sorry this is so long, but it's a life-changing decision I'm facing and wanted to be sure I told the whole story. Any help would be greatly appreciated!

[Escape_Pod 358]

Ugh, what a difficult decision! I had issues with GERD prior to surgery, and an upper endoscopy indicated I had a (probably large) hiatal hernia. One surgeon advised me that I could proceed with the sleeve if that was my preference, because the hiatal hernia was likely the cause of my reflux and could be fixed during surgery. A different surgeon strongly advised me to go with bypass, despite finding the hiatal hernia, because of the reflux issue. My impression was that the second surgeon was more cautious, because he's had a few sleeve patients with really awful reflux after the sleeve, which can be extremely difficult to manage, and can possibly result in having to do a revision to bypass to resolve it. (My understanding is that the patients were experiencing more extreme reflux, uncontrolled by medications. One was having regular pyloric botox injections -helps reduce the pressure in the sleeve, not sure what the side effects of that are - seems like you'd be prone to dumping like a bypass patient?, which is not a viable long-term solution.

I took my chances and decided to go ahead with the sleeve, but it was a very difficult decision, and I do think it was a risk, all the more so for me because I had to self-pay, and I'm not sure where I would have come up with the money if I'd have to have a revision!! So far, so good. I will admit, the Pepcid I was on immediately post-op didn't control my stomach acid, so I'm back on a PPI for now, which is working very well for me. My surgeon doesn't want me on it long-term though, because of the Calcium absorption issues.

I can certainly sympathize, I think with your need to take NSAIDs and the doubt over the hiatal hernia, your decision is much more difficult than mine was. Presumably they'd know for certain about the hiatal hernia once they're in doing the surgery, and you could have your surgeon make the final decision at that point based on what he finds, but I'm sure that's not a comfortable compromise either.

[smkeller 3]

You don't have Calcium absorption problems if you take the 'citrate' form of calcium with your PPI's. Your doctor should know this.

I need advice. I have gone thru the entire four-month process and am just days away from my sleeve surgery (just waiting for approval from the insurance company). However, I'm so worried by something that I am having trouble sleeping, unable to reach a decision. Like most of us, I have two choices for my surgery: RNY or VSG. I also have two medical problems; one is an issue with the RNY & the other is an issue with the VSG.<br /><br />I chose the VSG over the RNY for several reasons, the main two being I don't like the idea of having my intestines rearranged when the VSG works just as well & has less risks, and the other being because I have a back condition that causes me to take NSAIDs daily. I have a bulging disc & arthritis in my lower back, and also heel spurs. I take Naprelan 750mg every day and without it, walking and standing is very painful. This alone is enough reason to want the VSG over the RNY.<br /><br />However, I also have severe acid reflux. I do not have heartburn symptoms. Instead, when I have a reflux attack, I can't stop clearing my throat; it will last about an hour and is very unpleasant. When I take Nexium daily, that goes away - not a problem. However, whenever I get a cold or have allergies, I get a cough that lasts 3-4 months; 4 doctors have now told me that the chronic cough is due to acid reflux (the acid irritates my trachea or something). I had an endoscopy and they diagnosed a hiatial hernia. Then I had an Upper GI and they found no hernia, just severe reflux, esophageal spasms & rapid gastric emptying. So I don't know if I have a hiatial hernia or not; the tests showed different results and I don't know which is right.<br /><br />Here is my problem. My surgeon recommends the RNY for me, because of the reflux, which he says will probably get worse after a VSG. I pretty much decided against the RNY long ago because I don't want to give up my NSAIDs. The doctor says I can still take NSAIDs after a bypass, just in smaller doses and infrequently, but that goes against everything I've read and I'm not comfortable with it. Besides, I need them daily and small doses don't help me. I know losing weight will help my back, but I don't know how much it will help, and I'm not willing to take the gamble and live in constant pain because I can't take my antiinflammatory meds. (Not to mention that my back is getting steadily worse.)<br /><br />Which leaves me with the VSG, which is what I really want anyway. But I am very worried about the reflux. At this point, I don't know if I have a hiatial hernia. If I do, then the doc will repair it and it should be okay. But if I don't, am I condemning myself to a lifetime of chronic coughing (not to mention possible ulcers & esophagael cancer) due to uncontrolled reflux?<br /><br />Has anyone else gotten conflicting information (endoscopy vs upper GI) about whether or not they had a hiatial hernia? If so, which test was right?<br /><br />And if I don't have the hernia and go ahead with the sleeve surgery, what will happen with my reflux? Will it be permanent, or likely to go away when I lose weight? I don't mind taking meds the rest of my life, but I don't want this horrid cough forever. :-(<br /><br />Sorry this is so long, but it's a life-changing decision I'm facing and wanted to be sure I told the whole story. Any help would be greatly appreciated!

[Tiffykins 673]

The reflux might resolve after you heal since your horrible reflux could be a symptom of the hiatal hernia.

As for going with RNY to avoid reflux, personally, I'll take Nexium or Prilosec for the rest of my life to avoid the complications of RNY. Oh and NSAIDS with RNY are a total no go. I wouldn't ever risk the chances of an ulcer on the stoma. And, to this very day, I am so grateful that I chose VSG. Since the pregnancy, I have been diagnosed with a clotting disorder directed related to my platelets, and a clumping caused by a lack of a Protein factor. The ONLY treatment is an 81mg Aspirin every day for the rest of my life. My high risk ob was elated to find out that I did not have RNY because this treatment would not be possible.

Here's my reasons for VSG over RNY as my revision:

The VSG was my 2nd, and final WLS. I could have easily had RNY, but I fought to have VSG as my revision from the band. Some factors I considered in deciding on VSG. The pouch that RNY offers is similar to the pouch with the band. Least to say, a pouch sucks, I love having a normal tummy, just less capacity and still fully functioning.

1) No blind stomach left behind that can be difficult to scope yet can still get ulcers and cancer.

2) 2 years max on calorie/carb/sugar malabsorption, but a lifetime of vitamin/nutrient malabsorption. This process is called adaptation, and it happens with intestinal bypass surgeries.

3) I had a pouch with the band, and it sucked. I'm pretty fond of my pyloric valve and the sleeve let me keep it. I love having a normal functioning stomach, just smaller in capacity.

4) Regain stats and #of RNY patients seeking revision truly scared the poop out of me

5) I have too many friends in real life that struggle with Vitamin deficiencies post-RNY, and most of them either never got to goal, or have gained back a significant amount of their weight.

6) The long term complications with RNY were too numerous for my comfort level. Pouch or stoma dilation, strictures, vitamin/nutrient deficiencies, ulcers,

7) I researched gastrectomies that had been performed for stomach cancer and ulcer patients, and found comfort in the long term results and minimal complications of patients that had lost most or all of their stomachs had dealt with over several years.

8) I was a volume eater, and knew a restrictive only procedure would work for me. That was my thought process when I got the band, and I thought I could beat the odds on complications. Sadly, the band only lasted 8 months before I had to revise.

9) I did not want to have food or medication restrictions. I chose WLS to have a "normal" life, and I think it's normal to eat a couple of Cookies. With RNY, I wasn't willing to go through the possibility of dumping if I wanted to have a couple of Cookies, or a slice of cake on occasion. Nor was I EVER willing to have medication restrictions.

I lost all my weight in my ticker with the exception of 7lbs with the sleeve, and I did it in 10.5 months. The 115lbs fell off the first 6.5 months, and then the rest I lost as I was getting into maintenance over another 4 months.. It's been a fabulous journey, and I'm easily maintaining with zero issues for nearly a year at this point. I want to add that every WLS regardless of your choice will require discipline. Only a percentage of RNY patients dump on sugar/fat, pouches and stomas stretch, then you have the medication restrictions. I'm not trying to convince you, but these were my concerns when I knew I had to revise from the band. I started at 263 the day of my revision and today I weigh 127lbs. I bounce on the scale 125-130lbs any given week, and I couldn't be more ecstatic!

Best wishes in your research!

[CowgirlJane 14,261]

Can somebody explain to me why you are less likely to have reflux with the RNY? I never had reflux before being banded and the idea of the "pouch" and related problems of the RNY makes me "shudder". Anyway, I don't get how a revision from a sleeve to RNY solves the acid reflux since you have already lost that 85% of your stomach.

[Escape_Pod 358]

I believe it's the diversion of the bile in combination with the reduction of the stomach size that makes RNY so effective at eliminating GERD.

I'm grateful I was able to have the sleeve, but personally I'd rather have had RNY than no surgery at all, and ultimately, I think you have the trust the judgment of your surgeon of what's the best option for you and your medical situation. Particularly if you're already seeing damage to the esophageal tissue, which can put you at higher risk for esphageal cancer down the road. Having lost my mother to that form of cancer less than two years ago, I can tell you that's not a risk I'd want to take lightly.

Just my two cents.

SMKeller, you're correct that we take calcium citrate rather than Calcium carbonate it is better absorbed by post-surgery patients, but that's independent of the reseach on overall calcium absorption when on a PPI long-term. Scientists are still trying to determine exactly what's going on, since recent studies don't show a marked difference in calcium absorption, but there's still a subtantially higher risk of bone fractures. Since my surgeon is also a gastroenterologist and keeps up with the latest medical literature, I'm going to trust his opinion that ideally it would be best not to be on a PPI long-term.

[New start 4]

The reflux might resolve after you heal since your horrible reflux could be a symptom of the hiatal hernia.

As for going with RNY to avoid reflux, personally, I'll take Nexium or Prilosec for the rest of my life to avoid the complications of RNY. Oh and NSAIDS with RNY are a total no go. I wouldn't ever risk the chances of an ulcer on the stoma. And, to this very day, I am so grateful that I chose VSG. Since the pregnancy, I have been diagnosed with a clotting disorder directed related to my platelets, and a clumping caused by a lack of a Protein factor. The ONLY treatment is an 81mg Aspirin every day for the rest of my life. My high risk ob was elated to find out that I did not have RNY because this treatment would not be possible.

Here's my reasons for VSG over RNY as my revision:

The VSG was my 2nd, and final WLS. I could have easily had RNY, but I fought to have VSG as my revision from the band. Some factors I considered in deciding on VSG. The pouch that RNY offers is similar to the pouch with the band. Least to say, a pouch sucks, I love having a normal tummy, just less capacity and still fully functioning.

1) No blind stomach left behind that can be difficult to scope yet can still get ulcers and cancer.

2) 2 years max on calorie/carb/sugar malabsorption, but a lifetime of vitamin/nutrient malabsorption. This process is called adaptation, and it happens with intestinal bypass surgeries.

3) I had a pouch with the band, and it sucked. I'm pretty fond of my pyloric valve and the sleeve let me keep it. I love having a normal functioning stomach, just smaller in capacity.

4) Regain stats and #of RNY patients seeking revision truly scared the poop out of me

5) I have too many friends in real life that struggle with Vitamin deficiencies post-RNY, and most of them either never got to goal, or have gained back a significant amount of their weight.

6) The long term complications with RNY were too numerous for my comfort level. Pouch or stoma dilation, strictures, vitamin/nutrient deficiencies, ulcers,

7) I researched gastrectomies that had been performed for stomach cancer and ulcer patients, and found comfort in the long term results and minimal complications of patients that had lost most or all of their stomachs had dealt with over several years.

8) I was a volume eater, and knew a restrictive only procedure would work for me. That was my thought process when I got the band, and I thought I could beat the odds on complications. Sadly, the band only lasted 8 months before I had to revise.

9) I did not want to have food or medication restrictions. I chose WLS to have a "normal" life, and I think it's normal to eat a couple of Cookies. With RNY, I wasn't willing to go through the possibility of dumping if I wanted to have a couple of Cookies, or a slice of cake on occasion. Nor was I EVER willing to have medication restrictions.

I lost all my weight in my ticker with the exception of 7lbs with the sleeve, and I did it in 10.5 months. The 115lbs fell off the first 6.5 months, and then the rest I lost as I was getting into maintenance over another 4 months.. It's been a fabulous journey, and I'm easily maintaining with zero issues for nearly a year at this point. I want to add that every WLS regardless of your choice will require discipline. Only a percentage of RNY patients dump on sugar/fat, pouches and stomas stretch, then you have the medication restrictions. I'm not trying to convince you, but these were my concerns when I knew I had to revise from the band. I started at 263 the day of my revision and today I weigh 127lbs. I bounce on the scale 125-130lbs any given week, and I couldn't be more ecstatic!

Best wishes in your research!

[New start 4]

Incredibly helpful information!! I am new to all of this, and they found a hiatal hernia as a part of my pre-op workup- always thought I just had GERD. I will be having my sleeve in about a month, and they will repair the HH. Thank you for the education.

[fiera121 0]

I made the decision to go ahead with the VSG & take my chances. I figured I would rather deal with acid reflux than with not being able to walk. So, that being said... It's been a month today since my sleeve surgery. They found no hiatal hernia. And so far, no reflux symptoms. :-) I am taking a Nexium every day, but I was doing that before surgery, as well.