Have any of you dealt with a hiatal hernia AFTER getting sleeved? What ended up happening?

I am currently dealing with this. I haven’t yet found out what my surgeon wants to do, but I am afraid that I will be told the only option is to convert to RNY, and I absolutely do not want that. Have any of you had luck with simply repairing the hernia and keeping the sleeve instead of converting to RNY?
Do any of you have suggestions on doctors who may be experienced at dealing with this problem?
i appreciate any advice since it is hard to find info on this problem. It seems like tons of people have hernia repairs at the time they have the sleeve done but it seems less common to have it come up later.

Hi Lee,

just checking in. How are you doing?

1 hour ago, KateinMichigan said:

Hi Lee,

just checking in. How are you doing?

I'm getting there. I'm a little over 2 weeks post-op, no GERD or vomiting at all. I am back to eating tiny portions, most all soft foods. I need to monitor my liquid closely- I know I'm not getting enough fluid- but I get full so easily! It's kinda like the first few weeks after the sleeve surgery.

Wow! I’m so glad it’s getting better. Are you off all PPI’s? I can’t even image what that would be like. I can’t even have a few sips of water without gerd. I’m surprised to hear it’s like the first few weeks of sleeve - did they do any resleeve/reshape touch up? I’m going under in 2 weeks. How’s the brick on chest feeling? How’s the pain? Any tips/advice or surprises would be super helpful.

20 hours ago, leebick said:

I'm getting there. I'm a little over 2 weeks post-op, no GERD or vomiting at all. I am back to eating tiny portions, most all soft foods. I need to monitor my liquid closely- I know I'm not getting enough fluid- but I get full so easily! It's kinda like the first few weeks after the sleeve surgery.

I forgot to ask - did your doc use mesh? Did she tell you how many stitches?

7 hours ago, KateinMichigan said:

I forgot to ask - did your doc use mesh? Did she tell you how many stitches?

Hi-

My doctor did use mesh to repair the hernia opening, but didn't say how many stitches. I am not taking any PPIs, only took Tums once since the surgery (so almost 3 weeks). There is nothing in the surgical note about her having done any kind of touch-up on the sleeve. It's like the first few weeks when the sleeve was new in that I was on full liquids, finally worked up to a soft diet, but I can only eat a little bit before I get the "too much" signal from the sleeve. I have no GERD, no vomiting, no acid fumes, no block-like feeling in my chest, nothing. It's amazing. I have to pay close attention when I eat, take tiny bites, chew a LOT, and eat slowly. I can eat 3 bites of something and then on the 4th bite I am TOO FULL and it hurts; I definitely can feel the restriction from my sleeve again, which was something I was worried about. I was just out of town for a week at a family gathering (wedding and a memorial service, both postponed from originally scheduled due to covid) and I was able to eat much of the food being served. We were in New Orleans, so that is saying something! I just followed the rules for the soft diet and for mindful eating and it was OK, most of the time. Biggest challenge right now is staying hydrated, but that's always been an issue for me (even before having the sleeve surgery). I'm kind-of in awe how easy and life-changing this has been. All week I'd eat something and think WOW, I'm not throwing this up, it's staying down where it belongs!

On 3/4/2021 at 2:27 AM, SleevedK said:

Have any of you dealt with a hiatal hernia AFTER getting sleeved? What ended up happening?

I am currently dealing with this. I haven’t yet found out what my surgeon wants to do, but I am afraid that I will be told the only option is to convert to RNY, and I absolutely do not want that. Have any of you had luck with simply repairing the hernia and keeping the sleeve instead of converting to RNY?
Do any of you have suggestions on doctors who may be experienced at dealing with this problem?
i appreciate any advice since it is hard to find info on this problem. It seems like tons of people have hernia repairs at the time they have the sleeve done but it seems less common to have it come up later.

Hi I just had my VSG on July 7th. I did not know and neither did my surgeon that I had a hiatal hernia. She discovered it when she opened me up. So she clipped it while she was in there. Sometimes they are not picked up with EGD. She said it's a fairly simple procedure just a little more pain for me post op

So sorry to hear you ladies are going through this, can totally relate. I had RNY 3/20, had never had a hiatal hernia in my life and now one was discovered during an upper endoscopy earlier this week, 16 months post RNY. I’m totally baffled as to how this happened, not sure what my next steps can and will be. Right now Omeprazole every morning, being very careful. Hernia measures 2cm. Wish you all the best!

10 hours ago, leebick said:

Hi-

My doctor did use mesh to repair the hernia opening, but didn't say how many stitches. I am not taking any PPIs, only took Tums once since the surgery (so almost 3 weeks). There is nothing in the surgical note about her having done any kind of touch-up on the sleeve. It's like the first few weeks when the sleeve was new in that I was on full liquids, finally worked up to a soft diet, but I can only eat a little bit before I get the "too much" signal from the sleeve. I have no GERD, no vomiting, no acid fumes, no block-like feeling in my chest, nothing. It's amazing. I have to pay close attention when I eat, take tiny bites, chew a LOT, and eat slowly. I can eat 3 bites of something and then on the 4th bite I am TOO FULL and it hurts; I definitely can feel the restriction from my sleeve again, which was something I was worried about. I was just out of town for a week at a family gathering (wedding and a memorial service, both postponed from originally scheduled due to covid) and I was able to eat much of the food being served. We were in New Orleans, so that is saying something! I just followed the rules for the soft diet and for mindful eating and it was OK, most of the time. Biggest challenge right now is staying hydrated, but that's always been an issue for me (even before having the sleeve surgery). I'm kind-of in awe how easy and life-changing this has been. All week I'd eat something and think WOW, I'm not throwing this up, it's staying down where it belongs!

This is such great news! I'm so excited to see this!!!!! Thank you for sharing... it's given me such hope.

Observations. I’ve noticed a ton of people on this site who get VGS are waking up to a HH repair from a “surprise” HH. I had all the tests, and it didn’t show pre-op. It wasn’t until I experienced excruciating acid for the very first time when I awoke from surgery that I was sent to a specialist who found it. in my life I’m guessing that when they remove the stomach, the newly reduced and lighter banana stomach

Cont..

the new stomach is lighter and thinner, slides into the esophageal area because the new shape allows it to.

The seasoned docs now realize that the sleeve surgery actually causes this, so after they create the sleeve, they tighten the diaphragm so a hernia can’t slide up right away. (HH repair has a large fail rate).

why not be upfront about this? Why are so many waking up to the “hiatal hernia surprise!”

On 7/14/2021 at 5:34 PM, KateinMichigan said:

Cont..

the new stomach is lighter and thinner, slides into the esophageal area because the new shape allows it to.

The seasoned docs now realize that the sleeve surgery actually causes this, so after they create the sleeve, they tighten the diaphragm so a hernia can’t slide up right away. (HH repair has a large fail rate).

why not be upfront about this? Why are so many waking up to the “hiatal hernia surprise!”

You are absolutely correct that the shape of the sleeve stomach makes developing a hiatal hernia more likely later on than with a normal stomach. That is exactly what one of the research articles I found talking about hiatal hernias after sleeve surgery said.
I think the issue with people being surprised by a hernia repair during sleeve surgery is that sometimes sliding hernias are not detectable on the testing before surgery and are only discovered once the surgeon is actually looking at the stomach during the operation. I had no hernia repair during my sleeve surgery (which was in Dec 2016). I really don't think I had a hernia until about December 2020 (when I first noticed some weird symptoms that at the time I didn't understand but now in retrospect believe were from the hernia).

Your surgery must be coming up soon, so best of luck. Please do update us on how it goes.

Edited July 20, 20215 yr by SleevedK

7 hours ago, SleevedK said:

You are absolutely correct that the shape of the sleeve stomach makes developing a hiatal hernia more likely later on than with a normal stomach. That is exactly what one of the research articles I found talking about hiatal hernias after sleeve surgery said.
I think the issue with people being surprised by a hernia repair during sleeve surgery is that sometimes sliding hernias are not detectable on the testing before surgery and are only discovered once the surgeon is actually looking at the stomach during the operation. I had no hernia repair during my sleeve surgery (which was in Dec 2016). I really don't think I had a hernia until about December 2020 (when I first noticed some weird symptoms that at the time I didn't understand but now in retrospect believe were from the hernia).

Your surgery must be coming up soon, so best of luck. Please do update us on how it goes.

I totally agree, it's the shape/size of the sleeve that allows it to slip up through the opening in the diaphragm. My surgeon said more than half of my sleeve had slipped up into the thoracic cavity. No wonder I could hardly eat, had pain when I did, and would vomit more times than not!

I had my HH repaired a month ago, and it's been slow going since then. I am still trying to find foods that are comfortable when I eat. Mostly I'm still on full soft foods, as it just plain hurts when I try to eat meats, fresh fruit/veggies, etc. I saw the surgeon last week and she said to keep working at it, keep up with the mindful eating, and to add a 2nd protein shake to my daily intake. I was surprised to find that recovery from the HH surgery is VERY much like it was post-sleeve, eating-wise, and maybe even more challenging. I've lost 8 pounds in the month since the HH surgery. I am pleased about that, but it's due to not being able to eat much at once. I really don't care about eating, going out to dinner, etc., at all anymore. Probably good, maybe I'll hit that VGS goal weight after all!

9 hours ago, SleevedK said:

You are absolutely correct that the shape of the sleeve stomach makes developing a hiatal hernia more likely later on than with a normal stomach. That is exactly what one of the research articles I found talking about hiatal hernias after sleeve surgery said.
I think the issue with people being surprised by a hernia repair during sleeve surgery is that sometimes sliding hernias are not detectable on the testing before surgery and are only discovered once the surgeon is actually looking at the stomach during the operation. I had no hernia repair during my sleeve surgery (which was in Dec 2016). I really don't think I had a hernia until about December 2020 (when I first noticed some weird symptoms that at the time I didn't understand but now in retrospect believe were from the hernia).

Your surgery must be coming up soon, so best of luck. Please do update us on how it goes.

Hi K-

My surgery (and surgeon) has changed to August. (original Surgery clinic told me last minute that my insurance was “out of network and I’d be on the hook for the bulk of the cost).

Found a surgeon locally and just saw him this morning. He does it robotically. He was a straight shooter. Said my success rate is more like 70% - not 90. Why? Because over time scar tissue causes the HH bubble that formed above the diaphragm to become less amicable to reshaping back into a natural shape once pulled below the diaphragm. a lot depend on how much scar tissue and how I heal.

This misshape could still cause gerd. I’m just hoping that the surgery doesn’t make it worse. My new surgeon doesn’t feel it’ll make it worse. Gosh - such a hard decision.

1 hour ago, leebick said:

I totally agree, it's the shape/size of the sleeve that allows it to slip up through the opening in the diaphragm. My surgeon said more than half of my sleeve had slipped up into the thoracic cavity. No wonder I could hardly eat, had pain when I did, and would vomit more times than not!

I had my HH repaired a month ago, and it's been slow going since then. I am still trying to find foods that are comfortable when I eat. Mostly I'm still on full soft foods, as it just plain hurts when I try to eat meats, fresh fruit/veggies, etc. I saw the surgeon last week and she said to keep working at it, keep up with the mindful eating, and to add a 2nd Protein Shake to my daily intake. I was surprised to find that recovery from the HH surgery is VERY much like it was post-sleeve, eating-wise, and maybe even more challenging. I've lost 8 pounds in the month since the HH surgery. I am pleased about that, but it's due to not being able to eat much at once. I really don't care about eating, going out to dinner, etc., at all anymore. Probably good, maybe I'll hit that VGS goal weight after all!

Hi Lee,

I thought after a month it was supposed to get a lot better. The weight loss is a bonus, but the pain when eating sucks! Has the pain stayed constant - or is it slowly getting better? Is it really tight when you eat meats? Does it feel like it’ll get stuck? When does your surgeon say it’ll get better? What are some of your favorite foods/go to’s during this time? I’m guessing a lot of shakes - but do mash potatoes hurt too?

Thanks!

4 hours ago, KateinMichigan said:

Hi Lee,

I thought after a month it was supposed to get a lot better. The weight loss is a bonus, but the pain when eating sucks! Has the pain stayed constant - or is it slowly getting better? Is it really tight when you eat meats? Does it feel like it’ll get stuck? When does your surgeon say it’ll get better? What are some of your favorite foods/go to’s during this time? I’m guessing a lot of shakes - but do mash potatoes hurt too?

Thanks!

HI!

My surgeon is a GREAT bariatric surgeon, as far as doing the surgery, but she isn't on top of much regarding the nutritional aspects of the program. I finally called one of the nutritionists associated with the bariatric program. She said it's not uncommon for people to have more issues eating after the HH surgery than after the initial VGS surgery. She said that she thinks it's because when having VGS, there is that long internal suture line from forming the sleeve, but it's not connected or stitched to anything. With the HH repair, I've had my sleeve "tacked" to something internally, as well as mesh stitched into my diaphragm. Every time I breathe or swallow something, that all gets "pulled on" and that's what she thinks the pain is from, and also that the mesh repair narrows the opening in the diaphragm through which the esophagus passes. I don't know... I'm not a doctor and I don't play one on TV, hahaha, but it seems kind-of a reasonable explanation!

It's still a guessing game regarding eating. I eat soup for dinner at least half the time; not so much fun in the middle of summer, but it's food. I make sure the veggies in it are really soft and I can mash them up. Sometimes I can tolerate crackers in the soup, also. No pasta unless it's well mashed in sauce, but even then it's questionable. I mash up the macaroni in macaroni and cheese and it's OK, but when we had stuffed shells I only ate the filling and the cheese from the topping. No rice, no breads, even with a lot of butter. I had cereal recently (Lucky Charms) but had to wait for it to get soft in the milk. Eggs are OK, as is tuna salad and egg salad, but chicken salad today was disastrous. It's a different kind of pain than from the HH, more like a line of pain across the top of my chest. Salad is a no-no, has been all along, but right now I still struggle with ground meats (burger, turkey burger, etc). I do OK with corn on the cob, though, which is a gift as it's one of my favorite summer treats! I honestly never know what's going to sit well, although anything that is smooshed up in a gravy or sauce is usually OK, or meat that is fatty. I still have to take small bites and chew, chew, chew, but once it goes down, it STAYS down, which is a plus, and still NO GERD! Also no PPI, no tums, etc. I'm still not sure how any of this is supposed to go, but I am glad I had the HH repaired. I was tired of drowning in acid every evening and of vomiting up food daily.