Revision from VSG to Bypass

[Timberlynn Sleeved to DS 8]

I went for my EGD last week due to all the GERD I have been experiencing for over 5 months which has got worse and no OTC or RX medication is touching it.

Results of EGD: - Localized mild inflammation characterized by erythema and linear erosions was found in the prepyloric region of the
stomach. Moderate bile reflux into sleeve. Chronic Gastritis.

Doctor has me on RX Pepcid and I see him in 6 weeks to discuss revision to Bypass.

Personally I wish I would have went with the bypass instead of the sleeve when I had my WLS.

How was everyone's experience who had the revision to bypass that experience GERD. Was it gone after?

[NCL04321 151]

Follow user Sleeveto bypass2023. She is very knowledgeable

[Tomo 1,138]

It resolved my severe gerd and silent reflux.

[RickM 1,747]

I would want to look closely at this, verifying the bile reflux and determining if there is any acid reflux component to this before getting into long term treatment options as the treatment can differ widely depending upon that diagnosis. If it is bile, then I wouldn't expect Pepcid or other anti acid meds to do much as the are treating acid and not bile, a base. I'm not sure what meds they do use but likely different ones. Bile is used to neutralize the acid coming out of the stomach along with the digested food into the intestines.

Is your surgeon in the loop on these findings (I assume so, but check if you haven't heard from them yet,) as that may change his prescriptions.

If it is strictly a bile problem, then a bypass will probably correct it, but not guaranteed as it moves the stomach/pouch outlet downstream into the natural path of bile secretions; the key, according to one surgeon I discussed this with, is the length of the roux limb, as that is the one that connects the pouch with the mainstream intestine and how far any bile would have to travel to reflux into the stomach. This doc noted that at 80cm or greater (IIRC) he didn't run into any bile reflux problems.

The basic RNY procedure has been around for some 140 years for gastric cancer and gastroparesis (it is usually termed just a partial gastrectomy, or likely some other fancy latin names as well,) and it that use, bile reflux is a not uncommon complication. My non-MD take on it is that in those cases, they tend to keep the limbs short to minimize malabsorption and weight loss (last thing a cancer patient usually needs is more weight loss!) So, the longer limb makes sense here. Discuss this and make sure that your surgeon is up on this aspect of it.

The other option if it is basically a bile problem is the DS, duodenal switch, which is pretty much a guaranteed cure for any bile problems owing to the very long path between the bile ducts and the stomach, but relatively few bariatric surgeons offer it owing to its greater complexity. Note this only applies to the "traditional" or Hess DS and not the newer SIPS/SADI/"loop" or simplified DS, which like its mini-bypass cousin has bile reflux as one of its common complications. The DS will not help any acid reflux problem as it uses the existing sleeve (though may resleeve it if it was malformed causing GERD rather than just overproduction of acid,) while adding the intestinal rerouting for malabsorption. The DS is a better choice over the RNY revision if slow or inadequate weightloss is an issue, too, as it is a stronger metabolic tool.

Good luck on this - bile is surely a much less common problem with the sleeve than acid reflux, so the industry isn't quite as settled on solutions for it.

[ChunkCat 689]

Echoing RickM, bile reflux is different than acid reflux. Make sure you are dealing with a doctor who understands the difference, it matters a lot because best treatment and best course for revision are different between the two. I believe they should have you on something like cholestyramine for the bile reflux, it absorbs the excess bile. And yes, if bile reflux is the main issue, a traditional DS would be a useful revision because it cures it... So I'd research that and talk it over with your surgeon!