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Sleeve to bypass revision with arthritis



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In 2012 I had the gastric sleeve procedure, it was very successful until several events in my life caused me to slip back into old habits. Adding to that, my surgeon closed his practice and I had no one to follow up with locally. The old habits and lack of Followup care led to the weight slowly creeping back on.

Since my sleeve procedure I’ve been diagnosed with RA which I have under control for about the past year or more. Earlier this year I began experiencing severe acid reflux and my PCP suggested I see the new BS who had just come to town. The BS advised me (after scoping me) that I have a hiatal hernia that needs to be repaired. He also recommended that I have a revision to the bypass. Fast forward three months and several pre-op tests later and I receive a call from the doctors nurse telling me that the doctor has decided it’s best not to do the conversion to bypass because I have arthritis and take methotrexate. She goes in to explain, the doctor thinks the risk of ulcers from medication and the possibility of slow healing outweigh the possible benefits. I am a 38 year old otherwise healthy female with her RA well controlled.

Has anyone else experienced anything similar to this before? Has anyone had the conversion to bypass who was diagnosed with RA before their conversion? I’m incredibly frustrated and not sure what do to from this point. Any advice you can share would be much appreciated.

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Sorry I can’t offer any help in regards to a revision to bypass & rheumatoid arthritis. I did find the article below about managing methotrexate side effects. (I was interested because I have a non bariatric friend who takes it for RA too.) May be worth another conversation with the bariatric surgeon in regards to the suggestion that taking folic acid can reduce side effects. Repairing your hernia may alleviate some of your reflux issues too.

It’s unfortunate that while it’s helpful managing arthritic pain, methotrexate can also cause weight gain. ☹️

https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/methotrexate-managing-side-effects

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Your story is almost duplicated to mine. So I chose to go to the mayo Clinic… this started the beginning of my journey to a revision from the sleeve. Its scary but Ive come to accept it is the only choice for me. Im not currently taking any meds as my RA is in remission

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I just hate that it’s one or the other and there is no middle ground. My rhum has no concerns with me having a revision to bypass so I do not understand why the BS does. My rhum and I have even discussed possible meds after the transition.

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I think I would seek out a different BS. Get a different opinion. Thats what I did.. i figured there is no place better than the mayo Clinic. Im not sure where you live but. Reach out somewhere. You are only 38 years old. Acid reflux is extremely damaging to your esophogus. You are at risk for developing Barretts disease or eventually cancer. I think i would definately seek out more information. The Dr at Mayo Clinic in Phoenix is definately worth consulting. You can have all your records forwarded to them for review. Have appts through zoom. My bariatric journey started in 2013. The last 3 years fighting acid reflux and a sliding hernia has severly damaged my esophogus. From a stage 1 to a stage 4 in just 1 years time. It has to be fixed. Acid reflux is a very serious issue

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I am sorry you are dealing with this. If they won't do a bypass, the other options would be to just repair the hiatal hernia and see if that alone will stop the reflux, or to get a Linx device put on your sleeve: https://www.jnjmedicaldevices.com/en-US/campaign/LINX-GERD-relief

If you feel like you're not totally convinced you want to get the bypass then I would talk to the surgeon about those other options. Just doing nothing isn't an option, since bad reflux is such a miserable problem to deal with and can be so dangerous.

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On 6/22/2021 at 7:49 PM, Frostyauggie said:

In 2012 I had the gastric sleeve procedure, it was very successful until several events in my life caused me to slip back into old habits. Adding to that, my surgeon closed his practice and I had no one to follow up with locally. The old habits and lack of Followup care led to the weight slowly creeping back on.

Since my sleeve procedure I’ve been diagnosed with RA which I have under control for about the past year or more. Earlier this year I began experiencing severe acid reflux and my PCP suggested I see the new BS who had just come to town. The BS advised me (after scoping me) that I have a hiatal hernia that needs to be repaired. He also recommended that I have a revision to the bypass. Fast forward three months and several pre-op tests later and I receive a call from the doctors nurse telling me that the doctor has decided it’s best not to do the conversion to bypass because I have arthritis and take methotrexate. She goes in to explain, the doctor thinks the risk of ulcers from medication and the possibility of slow healing outweigh the possible benefits. I am a 38 year old otherwise healthy female with her RA well controlled.

Has anyone else experienced anything similar to this before? Has anyone had the conversion to bypass who was diagnosed with RA before their conversion? I’m incredibly frustrated and not sure what do to from this point. Any advice you can share would be much appreciated.

I have arthritis that took out both my hips in my early 40s. I have it in my back and joints too. I get steroid injections in back and neck when I absolutely have to. I cannot take pain meds except for tylenol and when its really bad I get norco. I also had the sleeve done but revised to RNY last year because I ended up with really bad GERD that gave me esophagitis D. Good luck

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I’m so sorry your dealing with this.. I too have RA and was revised this past May..My surgeon of course was aware of my RA but never showed any cause of concern regarding my revision .. I don’t know.. maybe see out another surgeon? I pray this all works out for you and please don’t give up.. best wishes to you

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