In recent years I’ve noticed a spike in the “Hiatal Hernia Surprise surgery” stories shared on the forums. That’s when you wake up to your surgeon telling you he fixed a “surprise hernia” while doing your sleeve. What gives? My 15 years of suffering with GERD after VGS, (I never ate a Tums before sleeve) has lead me to extensive research on this topic. I’ve read ever medical paper, report, blog I can get my hands on. I’ve met with and spoken to MANY surgeons on this subject. THEORY ABOUT “THE SURPRISE” I have a sneaking suspicion that the sleeve surgery itself leads to a hernia in many patients. (See stats about De Novo GERD and VGS). The new stomach is lighter and thinner, with more internal pressure and can now easily slide into the esophageal area past the diaphragm to create a HH because the new shape allows it to. I wonder if VSG surgeon don’t want to scare patients with the stats (30-40% chance of GERD without HH repair), so they just throw in the “hernia surgery surprise” to skirt the conversation. if this happened to you, please share the details- so many would benefit from your story. Knowledge is power! For those who haven’t had it yet - have the convo with your surgeon- let’s eliminate the “surprise”. I’m also sharing my journey to find a solution for those currently suffering from GERD after VSG. Not sure why post VLS GERD is still the “Wild West”. So many different opinions on how to fix it - sheesh. What I’ve been told to do by different surgeons over the years, and what I’ve learned: 1) “convert to rny” This was an instant turn off, but I get why so many do it. The pain is that bad for some. A seasoned WL surgeon recently told me the conversion to RNY is problematic long term (yet many still recommend it). He doesn’t do it anymore. He’s fixed hundreds of these HH post sleeve with a basic HH repair, no- and only had to covert 1 stubborn case. He said the conversion often leads to gas, malabsorption, vomiting, exhaustion, nausea, with many converts still ending up with GERD! If you’ve had the conversion and are a few years out - please share your experience. 2) “go with a partial wrap” This particular Doc said he’d “figure out what was best to do once he was in there.” I lost all confidence in him with that last statement, but I didn’t even realize this was a possibility if your fundus has expanded. 3) “get the LINX” I’m allergic to fake metals (I get hives), yet this particular surgeon was ready to slap this metal puppy around my esophagus. Luckily, the maker ( J&J) posted a warning on their site for sensitive skin types: “do NOT, under any circumstances, put this in your body”. I might have considered it if I didn’t have the allergy, although it seems very problematic for some. 4) “get the ligamentum procedure with repair” This is an old surgery for GERD that involves using your internal umbilical cord. Because it’s so new for WLS GERD, I asked the surgeon if one of his success stories could call me. He obliged. A very sweet women called me, and went on and on about how great the surgeon was. But then she told me she was still on PPI’s and now had chronic diarrhea and dumping syndrome…sooo…back to the drawing board. 5) “Get the basic HH repair”. I’ve consulted with 3 seasoned WLS surgeons who are all on the same page (finally). These 3 say that they pull my stomach back into the right spot, tighten the diaphragm, and call it a day. One uses mesh, but the other 2 sited a recent research paper saying there is no advantage to mesh. They all said I’d have a 80-90% chance of being able to go off the PPI’s. Sorta a fantasy promise- but I’m liking those odds. Of course I’ve done my research and discovered the fail rate over the long term is high (30-40%) after 10 years. and I might have minor swallowing problems, and bloating- yea! But I can have it adjusted if it gets bad, so that’s reassuring. So I’m going in with my eyes wide opened and doing the basic repair, I hope it works. The recovery is long and difficult, but my alternative is PPI’s that are cancerous. Wish me luck and thanks for reading my rant:) I hope it helped a few of my Gerdy sisters, and if you’ve had the “surprise”, please share your experience!