Extremely Dilated Fundus...Anyone Else?

[EllieV 16]

I had a VSG done back in October 2016.

Since, I have developed unbearable reflux to the point where I'm waking up in the middle of the night with my throat on fire and a mouth full of bile.

I had a swallow study done in August of 2020, which I was told was normal (recently found out it was FAR from normal...).

Fast forward to this past Spring, I saw a new surgeon who said that this anatomy is absolutely not normal for post-sleeve, and that I have an extremely dilated fundus and the beginnings of a hiatal hernia.

Has anything like this happened to anyone else? (the part in pink is circled because I wanted to point it out to a friend I sent it to, but obviously, that whole dark bubble should NOT be there)

[Tomo 1,137]

That is absolutely abnormal. Did your doctor say that it has been stretched over time? Did you get a barium swallow right after surgery to compare?

I don't have a dilated fundus, my sleeve looks good but my esophagus is really dilated instead, so I think that is the cause of the really bad reflux, Gerd Etc. and why my doctor suggested I get a revision to bypass. I hope you feel better soon.

[EllieV 16]

1 hour ago, Tomo said:

That is absolutely abnormal. Did your doctor say that it has been stretched over time? Did you get a barium swallow right after surgery to compare?

I don't have a dilated fundus, my sleeve looks good but my esophagus is really dilated instead, so I think that is the cause of the really bad reflux, Gerd Etc. and why my doctor suggested I get a revision to bypass. I hope you feel better soon.

Hi! No, they didn't do a baseline swallow study, so I don't have anything to compare it to, unfortunately. Fingers crossed that insurance approves my revision and we can get that corrected intraoperatively, too.

Thank you, and I hope you feel better soon too!

[EllieV 16]

Follow up: I actually just got the denial from my insurance company about an hour ago. Even seeing this, they’ve deemed a revision “not medically necessary.” I’m gonna have a fight on my hands 😩

[SleevedK 25]

I haven't had the enlarged fundus personally, but I have read about this happening to people after the sleeve. The "good" news about it is that it gives you additional options in how to treat the reflux. Most sleevers do not have enough fundus left for a fundoplication to control the acid to be an option, but since you have a larger fundus than normal, you probably can have at least a partial fundoplication (aka Toupet fundoplication). You may want to talk to a surgeon who does reflux surgery about that option if it is looking like they won't cover a revision to bypass.

[EllieV 16]

Update! I appealed the denial, appeal was denied again, took the next step which was an external review from a 3rd party company, and they deemed the revision medically necessary so now my insurance is legally bound to uphold that decision and cover it 100%. It took a while, but I won!

More excited about winning the insurance battle than I even am about the surgery, but I know it will sink in soon.

[SleevedK 25]

15 hours ago, EllieV said:

Update! I appealed the denial, appeal was denied again, took the next step which was an external review from a 3rd party company, and they deemed the revision medically necessary so now my insurance is legally bound to uphold that decision and cover it 100%. It took a while, but I won!

More excited about winning the insurance battle than I even am about the surgery, but I know it will sink in soon.

Glad it worked out for you. Hope your revision surgery goes well. Please update us on how you are doing after it is over.

[StratusPhr 127]

On 10/25/2021 at 8:37 AM, EllieV said:

Update! I appealed the denial, appeal was denied again, took the next step which was an external review from a 3rd party company, and they deemed the revision medically necessary so now my insurance is legally bound to uphold that decision and cover it 100%. It took a while, but I won!

More excited about winning the insurance battle than I even am about the surgery, but I know it will sink in soon.

This give me some hope. My insurance company wouldn't even open a case, my doctor couldn't send the clinicals, nothing. My husband got the HR person at the company involved and they at least gave a fax number to send the clinical information to. I hope it won't be a battle, but at least I know there is something beyond an appeal. Our insurance is with BCBS Anthem. Good luck, do you have a surgery date?