SleevedK

I just recently found out that there is a surgical procedure that might be helpful for those of us who have a hiatal hernia and GERD after the sleeve to repair the problem without having to convert to an RNY. It is called "Cardiopexy with Ligamentum Teres" (basically they wrap part of a ligament from your liver around the esophagus to reinforce the lower esophageal sphincter) Here is a recent article that discusses this technique if any of you want to show it to your doctor and get their thoughts. https://www.americanjournalofsurgery.com/article/S0002-9610(20)30814-X/fulltext#gr2 And here is a video of a surgery performing it: https://www.youtube.com/watch?v=t_SbDqhueRU Have any of you had this done, or at least been able to talk to your surgeon about it? It seems like this is not yet being done widely, so I would welcome any info any of you have about it. If you have had this done or know someone who did, what were their results like? Thanks!

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/

I am sorry that you have to go through another surgery but hope it helps your problems. Unfortunately, I have come to realize that it seems EXTREMELY COMMON over the long term that Sleeve patients end up developing hernias and reflux. I suspect that, as we get more info about the long term with this surgery, it will become clear that something needs to change about the surgical technique to prevent this from being such a common complication down the road. Knowing what I know now, personally I wish I had never gotten the sleeve - if I had gotten bariatric surgery, I wish I had gotten the RNY instead. At least the RNY has been around long enough that the surgical technique has been perfected and we know a lot about how people do with it over the long run. I really regret that I didn't realize what I was getting myself into when I had the sleeve. You guessed it - I too have a hiatal hernia and reflux. People need to be aware that this is an extremely common scenario after a few years with the sleeve.

Have any of you dealt with a hiatal hernia AFTER getting sleeved? What ended up happening? I am currently dealing with this. I haven’t yet found out what my surgeon wants to do, but I am afraid that I will be told the only option is to convert to RNY, and I absolutely do not want that. Have any of you had luck with simply repairing the hernia and keeping the sleeve instead of converting to RNY? Do any of you have suggestions on doctors who may be experienced at dealing with this problem? i appreciate any advice since it is hard to find info on this problem. It seems like tons of people have hernia repairs at the time they have the sleeve done but it seems less common to have it come up later.

Sorry that you have had a hard time. I am especially sorry to hear you are struggling with the horrible post-sleeve acid reflux. That is one of the things I hate about the sleeve: that it is basically a huge gamble that you won't be one of the unlucky ones who has hellish acid reflux after the surgery. If you are not able to get the RNY covered as a bariatric surgery, you may want to see if they can appeal it as being necessary for the acid reflux. After all, severe acid reflux is a health risk. We have had some threads here about other ideas on how to deal with the acid reflux, especially if you do in fact have a hiatal hernia :

Congratulations on almost being free of the lap band. I had a lap band for like 13 years and it caused me so much pain and misery over the years. Amazing how we put up with so much suffering because it starts to seem "normal". I ended up going with a sleeve revision, but knowing what I know now, I would have either gone with the bypass instead or just tried to live with my normal stomach. The sleeve's tendency to cause reflux and hiatal hernias is a real problem. I didn't understand back then just how bad it could get.

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

Call the surgeon's office. They will be able to tell you if it is concerning enough to go to the ER or if it can wait.

I agree that this is not normal. I too have regrets about getting the sleeve, but what you are experiencing sounds like a fixable issue. I would try to seek a second opinion if your surgeon is not willing to help you get an endoscopy scheduled.

Just wanted to bump this thread to check on how both of you are doing. Kate, any update about getting your surgery date? Lee, are you still doing okay with your recovery? My own plans for surgery were put on the back burner for a few reasons (some other family members with health issues that took priority, plus I felt like my symptoms had calmed down enough to be tolerable) but tonight I am having some terrible burning sensations that are making me think I need to do something sooner rather than later. It helps a lot to hear the experiences of others!

KateInMichigan, have you had your hernia repair surgery yet? I hope it went well if so. If you're still waiting, hope things move along soon!

I am glad that it seems like it is getting better. I did find a paper talking about this kind of thing happening after bariatric surgery, so apparently you are NOT alone : https://pubmed.ncbi.nlm.nih.gov/32558689/ It actually seems like a fairly common problem, which I wish I had realized before I ever had surgery.

Yes, the group is called "LINX Surgery for GERD/Acid Reflux/Silent Reflux/LPR". I believe you should be able to find it in the search on Facebook and request to join it. I have seen several people in the group who talked about how they had a gastric bypass to try to fix their acid problems, STILL had problems even after that, so then they got the Linx.

I am sorry that you are in this situation. It definitely sounds like you are really suffering, so I hope that the reversal helps you feel better. My situation is different than yours (I have a sleeve, which can't be reversed) but I definitely understand the feeling of regret for getting the surgery and wanting to go back to the way things were. The point of the surgery is to get healthier, not just to lose weight. I would just want to make sure that the doctor has tried everything possible to help your symptoms with non-surgical treatments before getting the reversal, since it would be really lousy to go through all that and then find out the problems are still there.

Ugh, I am sorry that you are still suffering with GERD after all that. Do you know if you might be a candidate for Linx? In one of the Linx groups on Facebook I saw that there were a few people who got Linx to control acid after a gastric bypass didn't work to stop it. The other thing I have read about is that sometimes people with the bypass end up with bile reflux from the intestines. The bile can cause a lot of throat irritation the same way that acid reflux can. I definitely think you deserve some additional testing to figure out why this is still happening after you have gone through so much.

Ugh, I am sorry that you were misdiagnosed for so long. I would definitely make a complaint at the first hospital so that hopefully the NP learns not to be so careless in the future.

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.

4 years post-sleeve, yes, I do regret it. The sleeve has a pretty high rate of revisions to gastric bypass in the long run due to either really bad acid reflux or inadequate weight loss. It also makes you more likely to get a hiatal hernia post-operatively, which may not sound like a big deal, but it has had a real effect on my quality of life. I didn't have a hiatal hernia until after the sleeve. Knowing what I know now, I would have never had bariatric surgery in the first place, because I was quite healthy in spite of being fat and bariatric surgery made my quality of life worse instead of better. However, if I did want to go through bariatric surgery, I'd rather get the RNY. At least the RNY has stood the test of time over many decades and cures acid reflux instead of making it worse like the sleeve does. Personally, I would only recommend bariatric surgery to people who already have health issues from being fat. Then it is worth the risk that the surgery might create its own problems.

Hi. I just wanted to check in with you guys and see how you were doing with your motility issues. Did you end up having surgery for it?

I am sorry that you are so miserable. Unfortunately some people do get really bad reflux after the sleeve. Sometimes the shape of the sleeve just causes it. Personally I have to take a combination of a PPI in the morning plus an H2 blocker at night to deal with my acid reflux. If it doesn't get better, you might need another surgery for it. Here are a couple of recent posts where we were discussing this issue of nasty post-sleeve reflux if any of the advice in the comments on that post is helpful to you.

Ugh, I am sorry that you are dealing with this problem. Rick's advice is solid. I suspect that he is correct that this nasty reflux is probably happening because you ended up developing a hiatal hernia. Hiatal hernias seem to be a VERY common complication of the sleeve long-term sadly, and reflux is the number one symptom they cause. You will very likely be offered a revision to bypass, since that is the "tried and true" way of fixing this kind of problem. However, some people have had good results just repairing the hernia and not doing a whole revision. If it does turn out you have a hernia, check out these recent discussions we have had about the issue:

Thank you so much for the summary of what you heard from the surgeons. This is actually the first time that I have heard a surgeon has noticed a trend of long term problems from sleeves revising to RNY. Thank you for making me aware of this. Sometimes I have wondered if I should do the revision to RNY since it is supposed to be the most reliable fix to this issue (and so many doctors push it as the best solution), but I definitely do not want to create new problems for myself. The other thing that scares me about the RNY is: if it doesn't go well, then what do you do?! Interesting that you got to talk to someone who had the ligamentum teres repair. Based on what I have learned in researching the Linx, I would wonder if her problems with diarrhea and dumping syndrome might mean that the ligamentum teres repair is pushing on her vagus nerve. The vagus nerve runs along the esophagus and stomach, and when the vagus nerve gets irritated, it can cause symptoms like that. I have seen people talk about how sometimes the Linx can cause vagus nerve issues, but never knew that could be a problem with the LT procedure too. Good to know. I think that an 80-90% chance of getting off PPIs with just a basic hernia repair sounds amazing. Do you mind telling me who the surgeons who said that are? Even if the repair doesn't last forever, maybe if you can get a few years of relief, there will be a better solution later on down the road.

For me, the surgery wasn't worth it. I believe it is the reason that I ended up with a hiatal hernia (I didn't have one before the surgery) and I have some moderate GERD problems since the surgery (though my GERD is not as severe as the GERD that some unlucky people end up with after the sleeve). Looking back on it now, I wish I would have just avoided any bariatric surgery at all, but if I were still going to get surgery, I personally think that the gastric bypass would have been a better way to go actually. I chose the sleeve because I was scared of the bypass and didn't want to take the risks of the bypass, but the bypass at least is the "tried and true" method that has stood the test of time over decades. The sleeve has a pretty significant risk of ending up with severe GERD, and if you get severe GERD, many doctors will tell you to get a bypass to fix the GERD. Then you end up going through ANOTHER surgery, which is riskier than just getting the bypass to start.

You are absolutely correct that the shape of the sleeve stomach makes developing a hiatal hernia more likely later on than with a normal stomach. That is exactly what one of the research articles I found talking about hiatal hernias after sleeve surgery said. I think the issue with people being surprised by a hernia repair during sleeve surgery is that sometimes sliding hernias are not detectable on the testing before surgery and are only discovered once the surgeon is actually looking at the stomach during the operation. I had no hernia repair during my sleeve surgery (which was in Dec 2016). I really don't think I had a hernia until about December 2020 (when I first noticed some weird symptoms that at the time I didn't understand but now in retrospect believe were from the hernia). Your surgery must be coming up soon, so best of luck. Please do update us on how it goes.

I am sorry that you have suffered so much. I think it is important for all of us to know what can go wrong with these surgeries so that hopefully people will know what kind of aftercare they need and to ask for help if things aren't going well before it gets out of control. I wish you the best on recovering from all of this!