Gastrojejunostomy

[Susan2008 9]

I’ve gone from band in 09 to sleeve in 2013. I have severe GERD, with many qualifying tests, my doctors want to preform a Gastrojejunostomy added to the sleeve. It is the malabsorption part of the roux en y procedure leaving the sleeve intact. There are papers on it saying it is a good added procedure and relieves the GERD and protects the esophagus from excess reflux. It is a hybrid procedure. Has anyone any information on this, heard of it?

[Mhy12784 423]

It sounds like youre pretty much having a sleeve to bypass conversion, and your doctor just wants to call it something that sounds more complicated and intelligent.

Having a gastric sleeve is basically the first part of a gastric bypass, so having a bypass after a sleeve is a fairly simple operation.

Its possible your surgeon is doing something slightly different, but the bottom line is itll be very similar to having a sleeve > bypass revision

[Susan2008 9]

Thanks. I agree with assessment as well. Just looking for others that may be similar

[RickM 1,753]

I have seen this referenced a couple of times before as a potential revision configuration, and it is distinct from a RNY conversion. With the RNY, they make a pouch with the tissue at the top of your stomach around the esophagus (whether from a normal or sleeved stomach) and join the bottom of that pouch to a limb of intestine typically 40-60cm downstream of the stomach, leaving the remainder of the stomach in place. What they are proposing in this variant is leaving the sleeved stomach intact, but making a hole in the side and joining that to a limb of intestine. So you wind up with two outlets to the stomach - one as normal through the pyloric valve at the bottom, and through the side into this "bypass loop".

The sleeve has some predisposition toward GERD by virtue that the volume of the stomach is reduced much more than the acid producing potential, and in some people the body never fully adapts to that change. The second factor influencing this problem is that the sleeve is considered to be a "high pressure" system in that when the pyloric valve at the bottom closes to allow digestion, any gas produced in the stomach has no where to go other than back up (the normal stomach will stretch a lot more to accommodate this) while an RNY is a "low pressure" system in that the pyloric valve has been bypassed along with the rest of the stomach, so any gas buildup in the pouch can vent down into the intestines (part of why RNY folks can be "gassier".

With this proposed configuration, any gas can be vented out this second outlet so it doesn't tend to force things back up, so there is some promise there, and since the duodenum is not entirely bypassed like on the RNY, there should be less of the nutritional deficiencies that are seen with the bypass.

A couple of concerns that I would have (as a non-expert, non MD) - one is the long term prospects for the configuration. The bit of cursory research on this that I could do online indicated that one of the main uses of this procedure is to bypass blockages in the bottom of the stomach from tumors and similar that for one reason or another are inoperable (like from late stage cancers.) Given the relatively low life expectancy of such patients, are there other longer term uses for this procedure that provide experience that would give one confidence that this will work for you in the long term?

The other potential problem that I see is that one of the weaknesses of the RNY is a propensity toward marginal ulcers, mostly around the anastomosis between the pouch and intestine because the part of the intestine that the pouch is now emptying into is not resistant to stomach acid like the duodenum (upper end of small intestine immediately downstream of the natural stomach), so that joint is easily irritated (this is the origin of the "no NSAID" rule for the bypass.) Now, this proposed configuration will have a similar anastomosis with similar sensitivities to acid, but with the sleeved stomach that is producing more acid than the typical RNY pouch - is this asking for trouble, or are there offsetting factors that address this issue?

Always like seeing new things here, I remain cautiously curious...

[jess9395 5,450]

On 07/28/2018 at 20:15, Mhy12784 said:

It sounds like youre pretty much having a sleeve to bypass conversion, and your doctor just wants to call it something that sounds more complicated and intelligent.

Having a gastric sleeve is basically the first part of a gastric bypass, so having a bypass after a sleeve is a fairly simple operation.

Its possible your surgeon is doing something slightly different, but the bottom line is itll be very similar to having a sleeve > bypass revision

This is incorrect. The sleeve is the first half of the Duodenal Switch procedure not the bypass. They are quite different.

[Mhy12784 423]

8 hours ago, jess9395 said:

On 7/28/2018 at 11:15 PM, Mhy12784 said:

It sounds like youre pretty much having a sleeve to bypass conversion, and your doctor just wants to call it something that sounds more complicated and intelligent.

Having a gastric sleeve is basically the first part of a gastric bypass, so having a bypass after a sleeve is a fairly simple operation.

Its possible your surgeon is doing something slightly different, but the bottom line is itll be very similar to having a sleeve > bypass revision

This is incorrect. The sleeve is the first half of the Duodenal Switch procedure not the bypass. They are quite different.

Let me rephrase that. With a sleeve the first part of the bypass is done, dissection and what not . A patient getting a bypass after a sleeve will typically be easier than a patient just getting a bypass.

[jess9395 5,450]

07/30/2018 05:51 AM, Mhy12784 said:

This is incorrect. The sleeve is the first half of the Duodenal Switch procedure not the bypass. They are quite different.

Let me rephrase that. With a sleeve the first part of the bypass is done, dissection and what not . A patient getting a bypass after a sleeve will typically be easier than a patient just getting a bypass.

Still not accurate. Bypass creates a pouch, as was said above. Sleeve does not. The statement that her doctor is just using a fancy word is inaccurate and an unfair characterization.  It’s an actual procedure. 

To the OP—there are a lot of conversion patients in here. If you do a search you will see lots of discussion that might help you!  

[Susan2008 9]

Thank you. I’ve been searching, but have not come across this particular solution my surgeon proposes. I don’t disagree with him as it sounds viable, I am trying to do my due diligence.

Thank all of you again.

There is an article, abstract only on line for this : “ Effects of Adding Gastrojejunostomy to Sleeve Gastrectomy on GERD, food Tolerance, and Weight Loss: A Randomized Study.”

i would be interested in opinions on this if someone reads article.

[MarinaGirl 609]

OP: I’m so sorry you’re going through this. It sounds complicated and confusing. I would get a second opinion from another bariatric practice that has extensive revision experience. They’re the best ones to guide you and provide accurate medical assessment, not us random folks on the Internet. Good luck.