Sleeve or Bypass? Confused

[GinSunflowers 1]

So my bariatric doctor is trying to convince me to get the sleeve instead of the Bypass, which I thought would be better for me being that I have GERD & a hiatal hernia. He says he can fix my hiatal hernia and after he fixes it, I would be fine and won’t develop another hernia. Now I’m confused and not sure which surgery would be the best for me. Has anyone who’s had the sleeve ever developed a second hiatal hernia after it was originally fixed during a sleeve surgery?.

[mi75 1,235]

I actually had severe diagnosed GERD for nearly 20 years pre-surgery and took ridiculous amounts of PPI. I also had my heart set on RNY because I was under the impression that VSG wasn't an option. My surgeon gave me the choice, saying that post surgery, once I lost the weight, the GERD would go away.

I chose VSG. I'm glad I did. During my surgery I also got a hiatal hernia repair and a fundoplication. Once I lost my weight the GERD was GONE. In total transparency, I've had a small amount of regain and it DID return but I'm working my way back down so meds are also gradually decreasing.

The main reason I'm glad I did VSG is because I had absolutely ZERO complications, no healing issues, had no malabsorption and just felt great in general. I did eventually develop lactose intolerance, but I'm told that can happen with either surgery.

[I♡BypassedMyPhatAss♡ 800]

Sleeve and Lap Band operate under a high pressure system. It puts a lot of pressure on your esophageal sphincter. Some people with these surgeries develop issues with GERD and esophageal motility issues years after having their surgeries. Sure GERD will go away with weight loss, but after years of high pressure on the sphincter, GERD can manifest again.

I had a Lap Band for seven years and had it removed a year ago due to GERD and revising to RNY soon.

[GinSunflowers 1]

On 03/08/2022 at 20:06, WhispersOfAngel said:

Sleeve and Lap Band operate under a high pressure system. It puts a lot of pressure on your esophageal sphincter. Some people with these surgeries develop issues with GERD and esophageal motility issues years after having their surgeries. Sure GERD will go away with weight loss, but after years of high pressure on the sphincter, GERD can manifest again.

I had a Lap Band for seven years and had it removed a year ago due to GERD and revising to RNY soon.

Thank you, but it was Bypass not lap band

[I♡BypassedMyPhatAss♡ 800]

3 minutes ago, GinSunflowers said:

Thank you, but it was Bypass not lap band

Yes, I'm aware. I gave you my personal experience with GERD and high pressure system wls's, which is VSG and Lap Band. My surgeon said since I have a history of GERD, even tho after my band was removed, the GERD disappeared, she said VSG wasn't an option, due to the damage that the GERD has done. I was only giving you my experience as an FYI, hopefully it will give you some food for thought on which surgery to choose.

[GinSunflowers 1]

On 03/08/2022 at 20:23, WhispersOfAngel said:

Yes, I'm aware. I gave you my personal experience with GERD and high pressure system wls's, which is VSG and Lap Band. My surgeon said since I have a history of GERD, even tho after my band was removed, the GERD disappeared, she said VSG wasn't an option, due to the damage that the GERD has done. I was only giving you my experience as an FYI, hopefully it will give you some food for thought on which surgery to choose.

Oh ok I see. Thank you

[Arabesque 6,488]

The surgeon may be basing their recommendation for sleeve over bypass because of the severity of your gerd & what damage it has caused.

I had occasional reflux, which isn’t as severe as gerd, for decades before my surgery. I managed it with diet (no spicy food, no high fat, rich or creamy foods, only occasional carbonated drinks - champagne & tonic in a G&T - little or no caffeine). I only needed to take a ppi a bare handful of times a year. My surgeon recommended a sleeve too because I was managing my reflux well & it was consequently a pretty minor case. Do I still have reflux? Yes, but it manifests itself differently. Hiccups not as severe, no bad taste in my mouth, though I have burning in the back of my throat 3 or 4 times a week at night. I do take Nexium every morning now which my surgeon warned me I’d have to.

But if you’d feel more comfortable with bypass, you have the right to request that surgery.

[kcuster83 1,502]

I have severe GERD as well. I went into my appointment prepared to discuss the sleeve and he was highly against it due to my GERD. Recommended bypass and gave his reasons, i researched and agreed. I have bypass on the 21st.

Apparently A LOT of people develop GERD after the sleeve surgery, even when not having it previously.

Mine is horrible and there was no way I was chancing making it worse, I am hoping it goes away completely!

[Guest]

Are sleeve and roux-en-y bypass your only options?

[I♡BypassedMyPhatAss♡ 800]

56 minutes ago, kcuster83 said:

I have severe GERD as well. I went into my appointment prepared to discuss the sleeve and he was highly against it due to my GERD. Recommended bypass and gave his reasons, i researched and agreed. I have bypass on the 21st.

Apparently A LOT of people develop GERD after the sleeve surgery, even when not having it previously.

Mine is horrible and there was no way I was chancing making it worse, I am hoping it goes away completely!

Yep, same. My surgeon said if I was set on sleeve, she wouldn't operate, lol.

I'm so glad she has my best interest at heart.

[kcuster83 1,502]

12 minutes ago, WhispersOfAngel said:

Yep, same. My surgeon said if I was set on sleeve, she wouldn't operate, lol.

I'm so glad she has my best interest at heart.

I didn't really argue too much, I just asked for information as to why he recommended the bypass. I see a LOT of people talking about GERD on these forums after they had the sleeve so I am comfortable with my choice.

I don't really know if he would have done the sleeve if I was adamant or not.

[ShoppGirl 3,382]

What makes you think that you will develop another hernia? Did you read somewhere that is common or something?? I don’t know anything about it but I would express your exact concerns to the doctor and let them give you statistics to help make your decision.

[GinSunflowers 1]

On 03/09/2022 at 09:18, MiniGastricBypassDude said:

Are sleeve and roux-en-y bypass your only options?

Yes

[GinSunflowers 1]

On 03/09/2022 at 09:18, MiniGastricBypassDude said:

Are sleeve and roux-en-y bypass your only options?

Yes

[SleevedK 25]

While it is indeed standard practice to repair hiatal hernias with a gastric sleeve operation, I don't think any doctor can guarantee you that your hiatal hernia will never come back. The things I've read indicate that the gastric sleeve seems to make your stomach MORE likely to herniate (since a sleeved stomach is narrower and therefore can slide up through the diaphragm hiatus more easily than a normal stomach). I know for a fact that there are some gastric sleeve patients who have had multiple hiatal hernia repairs after the surgery (and others who were told to convert to a bypass because of their hernias).

As far as the acid reflux issue, worse acid reflux is a known risk of the gastric sleeve. Some people are lucky and have no issues, but others do develop acid reflux for the first time after the sleeve or have much worse acid reflux after the sleeve. I would definitely ask him about why he thinks that this is not a concern in your situation and what his plan would be for how to deal with it if your acid reflux does get worse after the surgery. (If he tells you that you would just take a PPI for the acid if it gets worse after surgery, keep in mind that PPIs are not enough to control the acid for some people who have really bad acid reflux after the sleeve).

You are smart to be thinking about these issues before your surgery. Personally, I deal with both acid reflux and a hiatal hernia after the sleeve (and no I didn't have a hiatal hernia before the sleeve - they looked for it when they did the sleeve). Knowing what I know now, I never would have gotten the sleeve. I think the bypass has stood the test of time better than the sleeve has - after decades of experience with the bypass, surgeons know the risks of the bypass and are better at managing them, whereas problems with the sleeve are often handled by just converting over to the bypass anyway. Just look at all the stories on the revision forum about people converting from sleeve to bypass because of sleeve problems:
https://www.bariatricpal.com/forum/1302-revision-weight-loss-surgery-forums-new/

Edited March 11, 2022 by SleevedK