Possible sleeve to bypass revision

[peacefullillypad 2]

I had the sleeve and hiatal hernia repair done 4/7/15. I lost 74lbs in 5 months. I have had GERD since 1999, and I told my surgeon at my consultation. He suggested the sleeve and I trusted him to know the right procedure for my situation. The first 6 months were ok with slight heartburn. After about 6 months the heartburn came back full force and worse. In 2017 I had 3 EGD's, 2 Upper GI's and the LINX procedure with a repair for my hiatal hernia again. After the LINX procedure I was so sick I could not get down anything thicker than pudding for 6 weeks. At my last Upper GI two weeks ago, the Dr performing the test told me that I had the worst reflux he has ever seen. You could see that the barium liquid was not going down and I had to drink a full 8 oz to get the little pill to go through my esophagus. The only foods I can eat without pain are very soft liquids. I can eat some chicken but I have to drink Water to get it to go down. We have tried all the meds and my gastro says there is nothing else he can do to help me. I am looking into a revision to sleeve. I don't know if my insurance will cover another surgery. I have gained back 29lbs and I am miserable. Some days even water gives me reflux. Looking to hear from anyone that has had a revision from sleeve to bypass because of GERD and how you are doing now.

Edited January 21, 2018 by peacefullillypad

[James Marusek 5,244]

I am sorry to hear about your difficulties. Generally sleeve surgery is not recommended for GERD patients because the sleeve will only make that condition worse. RNY gastric bypass is the recommended procedure. I had RNY surgery about 5 years ago and one of the reasons why I went that route was because I had severe acid reflux (GERD). There are several past and present members on this board who had revisions from sleeve to RNY gastric bypass because of GERD. And they seemed to report that the revision worked for them. Perhaps some of them will speak up.

But before you go forward, you might want to consider the following:

According to the internet:

Nausea and vomiting are the most common complaints after bariatric surgery, and they are typically associated with inappropriate diet and noncompliance with a gastroplasty diet (ie, eat undisturbed, chew meticulously, never drink with meals, and wait 2 hours before drinking after solid food is consumed). If these symptoms are associated with epigastric pain, significant dehydration, or not explained by dietary indiscretions, an alternative diagnosis must be explored. One of the most common complications causing nausea and vomiting in gastric bypass patients is anastomotic ulcers, with and without stomal stenosis. Ulceration or stenosis at the gastrojejunostomy of the gastric bypass has a reported incidence of 3% to 20%. Although no unifying explanation for the etiology of anastomotic ulcers exists, most experts agree that the pathogenesis is likely multifactorial. These ulcers are thought to be due to a combination of preserved acid secretion in the pouch, tension from the Roux limb, ischemia from the operation, nonsteroidal anti-inflammatory drug (NSAID) use, and perhaps Helicobacter pylori infection. Evidence suggests that little acid is secreted in the gastric bypass pouch; however, staple line dehiscence may lead to excessive acid bathing of the anastomosis. Treatment for both marginal ulcers and stomal ulcers should include avoidance of NSAIDs, antisecretory therapy with proton-pump inhibitors, and/or sucralfate. In addition, H pylori infection should be identified and treated, if present.

You would want to rule out the possibility of a Helicobacter pylori infection. This is common bacterial infection but generally it is a hidden infection. About 2/3 of the people in the world have it. And this condition if you have it needs to be treated, so make sure you were tested for it, because it might be the root cause of your problems.

[teach2017 6]

I just had the revision from sleeve to bypass for severe GERD on Jan 10th. They also found my stomach in my chest cavity with a huge hernia they did not see after a year of tests. So far so good but I am on a meds for 6 months post op, then I can go off of them