I'm new here and haven't even introduced myself yet, so forgive me for skipping that part and jumping straight in with a question, but my surgery is scheduled for exactly 1 week from today and I'm feeling the need to get a decision made quickly.

I've been in preparations for bariatric surgery for a year now. The plan was always for sleeve. The intestinal rerouting thing just scares the bejeezus out of me, but it's really the rates of longterm complications that scare me the most about RNY, especially the "lightning strike" complications like internal hernia that can pop up unexpectedly years down the road, probably when you're hiking and about 100 miles from any decent hospital if you have my luck. I was much more comfortable with the idea of VSG.

However... I have a long history of GERD. It's milder when I lose weight but still there, and I had to switch from ranitidine to a daily PPI (omeprazole 20 mg) several months ago because the ranitidine just wasn't doing it for me anymore. Even with the PPI, I've sometimes had breakthrough heartburn and admit I've taken a second omeprazole later in the day every now and then for it. I figured I'd just have to stay on a PPI after surgery and convinced myself that would be a better option than taking on the added risks of RNY, but my pre-op EGD this morning showed LA grade A esophagitis (i.e. mild esophagitis) and a small hiatal hernia. Those were just the initial impressions and the final report and biopsy results aren't in yet, but the surgeon showed me about how big the hernia is and I'd guess it's 2-3 cm.

He says no problem, it can be fixed during surgery and we can treat GERD with medications or, eventually, even LINX if needed, but I'm concerned for a few reasons. It seems ominous to me that I have even mild esophagitis after several months adherence to a PPI regimen that's supposed to heal acid damage. I'm thinking that means I'd have to be bumped up to a higher/more frequent PPI dose after surgery just to keep things stable if I'm lucky. I'm a research person, so I've reviewed most of the recent research regarding GERD and the sleeve, and it looks like there is a large chance of the esophagitis worsening in grade after VSG. It also looks like there's a huge chance of recurrent hernia despite repair and as much as a 1 in 8 chance (according to one small study) of needing revision to RNY later. With that factored in, my chances of needing additional surgery after a sleeve actually appear to be the same or higher than my chances of needing additional surgery after RNY. I also wouldn't look forward to having to pay for EGDs every year to reassure myself that my esophagitis hasn't turned into Barrett's.

The general consensus of everything I've read leans toward RNY over sleeve for preexisting GERD, but this doesn't match my surgeon's encouragement to go with sleeve. Then again, he might have that can-do attitude because he knows how much I originally wanted the sleeve? I don't know. Anyway, needless to say, I'm having major second thoughts about the sleeve, but I have so little time left to decide and I'm worried about making the wrong decision. I was hoping my EGD results would give more clarity, but they just seem to have made the waters even murkier.

If you made it through that longgg post, I guess my question for you guys is: Am I being overdramatic about a little heartburn? Did any of you have esophagitis on your pre-op EGD? Which surgery did you choose and how did it work out? All opinions and anecdotes welcome and thank you in advance!

Edited January 14, 20197 yr by carolinafirefly

I had no clue about the villi growing back, GreenTealael. Informative AND you made me laugh, which I needed. Thanks ?

And how did you know I applied for that Mars One thing? I didn't get picked though *sigh*

Edited January 16, 20197 yr by carolinafirefly

3 minutes ago, carolinafirefly said:

I had no clue about the villi growing back, GreenTealael. Informative AND you made me laugh, which I needed. Thanks ?

And how did you know I applied for that Mars One thing? I didn't get picked though *sigh*

Didn't Everyone...

Definitely not, I can't think of anything worse

Really? What's so awful about being bombarded with radiation on a dusty, barren rock 55 million miles away from everything and everyone you've ever loved? It'd be an awfully big adventure and totally worth the risk <--- *says while being scared of a little surgery*

I called the office back today to ask some questions about the Barrett's like whether it was short or long segment and if there was any dysplasia. I got a call back from the nurse a little later with, "It's short segment, no dysplasia, and <long pause> the doctor says to stay off the internet." So busted ?

That is the best comeback from a Doc. Love it

Just now, elcee said:

That is the best comeback from a Doc. Love it

Me, too. I think I love my doctor now.

I wish I would of had the bypass instead of sleeve, like you I had mild Gerd before surgery but now after the surgery I am taking two different medications cause my gerds/ heartburn got worst. Some patients it went away after losing weight so I thought that would be me cause I felt the same way you did not wanting to go with a risky surgery go with the safe one.

Keep us updated as you go along with your surgery recovery. If you do have to have revision I'll be happy to welcome you to that side of the street, no matter what , I'm still your friend.

I have Barrett's and am getting the RNY. I would rather have done the sleeve also, but this is really the only option for me. Also have the hernia and quite a bit of dysplasia on the esophagus. My surgery is scheduled for 25th and I am trying to read everything I can get my hands on so I know what to watch for. The big book on gastric bypass was a life saver! So many questions answered! My surgeon has been pretty patient with me too, but knowing I had Barrett's he was pleased I had "chosen" the RNY despite the drawbacks just because of the benefits be of getting all that acid away from my pyloric valve and the near by tissue that has been taking a bath despite 40mg of Omeprazole a day [emoji22].

On 1/15/2019 at 6:38 PM, carolinafirefly said:

Well, I spent most of the day still trying to make a decision, and then the phone rang. As soon as I heard my surgeon's voice, I knew what he was gonna say because surgeons don't just call you themselves for no good reason.

The biopsy of the "LA Grade A esophagi" showed Barrett's. Decision made. But man, am I scared about surgery on Monday. The weirdest fear running through my mind tonight: What if the zombie apocalypse happens and I survive the zombies just to run out of Vitamins and die a slow death from malnutrition? My son's been playing The Last of Us lately, so that might have something to do with it, but it's true that I'm nervous about being so reliant on vitamins.

My family, who didn't support me that much in my decision to get WLS in the first place, is even more worried now, especially my mother. I get it. I'd be anxious if it were my son getting the surgery. I'd be like, "What? I made you with a perfectly good intestine, and now you wanna go cutting it up?" No, not really, but I'd think it. Speaking of my son, he's pretty anxious about the whole thing, and I hate worrying him. Another stressor is the fact that GreenTealael was right! They have to resubmit to my insurance company! The surgeon mentioned this, and we're both just hoping it gets approved in time for my surgery date to stay the same. The sleeve was approved in only 1 business day, so hopefully it won't take longer than that.

On top of all of that, I'm now scared about the Barrett's. I didn't even find out from the doctor if I have any dysplasia with it before hanging up. He just said we'd do another EGD in a couple of years. I'd imagine we'd be doing more than that, maybe, if there were already dysplasia, but I really don't know. I'll have to call and ask tomorrow. Right now, I'm scouring bariatricpal forums for stories from others who had Barrett's and had a really good outcome from gastric bypass. If any of you have a story like that or know of any, please share!

Hi, So I can totally relate to what you are going through but if you are going to have WLS then your only real option is RNY. I also started out to only want the sleeve surgery but during my EGD they found Barrett's. I had suffered with GERD for years and my surgeon wanted me to do the RNY from the start. After they found Barrett's my insurance company would only pay for the RNY. By this point I knew the sleeve was no longer an option.

BTW, I have done great with the RNY and I do not have GERD but I do take meds for the GERD. I also have been told to have a EGD every year. My surgeon says that a year after my WLS that he will recommend another surgeon who can repair my esophagitis at UPMC.

Edited January 20, 20197 yr by ScoutCR

On 1/15/2019 at 4:08 PM, GreenTealael said:

Best thing about the zombie apocalypse and being marooned on Mars is you'll likely run out of food before vitamins...

Silver linings

You'll do great, eventually the villi (sp) grow back in the intestines and malabsorption risks decrease the further out you get. The body is wonderful and resilient (like it's owner)

You're going to be amazed by what a difference a year will make, promise.

A clarification on the malabsorption is probably in order here. Yes, the villi do tend to grow back and in time, typically 1-2 years, the caloric malabsorption dissipates; however, the nutritional malabsorption persists.

Calories can be absorbed most anywhere along the small intestine, but nutrient absorption occurs in more specific regions of the intestine. For instance, mineral absorption primarily occurs in the duodenum (the part of the small intestine immediately below the stomach, which is bypassed along with the stomach in the RNY), and the villi in other parts of the intestine do not change their character to adapt what they absorb to any great degree. So, one's iron or calcium supplement needs won't change significantly, and will likely degrade over time as aging takes its' toll; need for periodic iron infusions is not an overly unusual result in time.

As a semi-related aside, the Duodenal Switch, which is overall more malabsorbing, does have long term caloric malaabsorption (which is why it has better overall regain resistance than other procedures) but it's nutritional malabsorption is likewise effectively forever (though of a somewhat different character to that of the RNY).

44 minutes ago, RickM said:

the nutritional malabsorption persists.

Can you provide the OP with some good sources to find this information?

Thanks

Edited January 23, 20197 yr by GreenTealael