Nervous about revision

[KadieEuropeBound 11]

Hello. I'm scheduled for revision surgery from VSG to Gastric Bypass this coming Sept 19th. With this long wait, my anxiety of the revision surgery is making me second guess having this surgery.

Background, I was sleeved 2 years ago. I was diagnosed with Gerd pre-op. My surgeon did recommend the Bypass but I had my heart set on the Sleeve. Had repaird my hiatal hernia at the same time as the Sleeve. My surgeon office requires a yearly endoscopy. It was at my 1 year follow up where the results still shown gerd. I was prescribed omeprazole 20 mg. My Gerd has vanished. Fast forward to 2nd year follow up this past June. I was complaining of bad heartburn and some occasional vomiting of acid if I have eaten close to bed time.

I was thinking in my head maybe my Gerd is behavioral related. So, i have moved my evening meal to no later than 5pm, chewing my food well and limited my portions. Well, mid June I had a major allergy attack. From there, my acid reflux was extremely bad that I've ended up in the ER. I have met with my surgeon the day before 4th of July.

He told me that I could have a revision to bypass or stay on PPI medicines. He had prescribed me protonix and suralfate. It has been a month and both medications have been working.

Now my concerns. I'm nervous about the Bypass mainly the dumping issues. I wonder if the PPI can be ta6kint long term. I'm 44 years old. My endoscopy and upper GI both showed mild gerd and a sliding hiatal hernia.

I understand the Gastric bypass will alleviate my symptoms of Gerd. Medications are helping now but would the effectiveness wears off in years to come. I don't want to regret the bypass.

I'm just scared of the journey.

[JediMom 66]

PPIs can be taken as lifelong medication and the effectiveness should not wear off. You have to determine what is best for you and not rush into anything if you feel you haven’t made a good decision yet.

[SeattleLady 277]

You have to do what's best for you! Do the research! In my case, revision is the best option. I have GERD, gastritis and a hernia. I am often in pain. In my research, long time use of PPIs at this stage for me is not a good option. Research and don't be afraid. Talk with your doctor. Then make a decision. For me, I afraid of not having the procedures.

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[KadieEuropeBound 11]

@Jedilady thank you for your response.

@Seattlelady also, thank you for your response too.

It's great to know that PPI medicines can be taken long term. I still have time to think about the decision to get a revision or keep taking my acid reflux medications.

[catwoman7 11,215]

only about 30% of RNYers dump. I know many (including myself) who have never dumped. For those who DO dump, it can be controlled by limiting your sugar intake, which we all should be doing *anyway*.

there's been a lot of press lately about PPI's being fine for the short-term but not the long-term. I don't know if the jury is still out on that or not, but it's been in the news a lot the last year or two.

[SeattleLady 277]

only about 30% of RNYers dump. I know many (including myself) who have never dumped. For those who DO dump, it can be controlled by limiting your sugar intake, which we all should be doing *anyway*.
there's been a lot of press lately about PPI's being fine for the short-term but not the long-term. I don't know if the jury is still out on that or not, but it's been in the news a lot the last year or two.

Yes, that is what I found too! Longterm use of PPI's are not good for your body.

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[ummyasmin 1,603]

Ha! My surgeon gave me a mini-gastric bypass and told me I have to take omeprazole for life just to make sure I don’t get ulcers (more of a risk with the MGB??) so I wouldn’t necc. make the decision on whether you need to take PPIs for life, only. You might end up needing to take them anyway.

[deletedprofile123 34]

I'm sorry for all you have been going through. I also have a sliding haital hernia, by the way. Makes it possible to eat well some days and some other days, I can't get anything down. Since you had a hernia before the sleeve and it is back now, if repaired again without converting to the bypass, according to my surgery, the hernia will likely return in 3-5 years, unless your diaphragm is supported with a mesh filter. Making the decision to have any WLS is difficult enough, let alone having to decide on a revision. It really comes down to quality of life, from what I've experienced and heard in support group for months now. If you feel you can manage your reflux well enough with medication, then maybe surgery is not worth the risk but acid reflux could lead to other things down the line... In my case, there is a plethora of reasons for revision, so that in a way, has made it easier to decide (scheduled for 9/9/19). Also, regarding your main concern (dumping), I actually have that now with the sleeve (maybe 3-4 times a month). It happens when I make poor choices (high sugar or high fat). Yes, it's more likely to happen with the bypass, but I think managing our intake regardless of surgery type is key to preventing uncomfortable dumping situations.

I'll have surgery just 10 days before you, so if you'd like, let's keep in touch and I'll let you know how it goes! I am most likely to have an open surgery (surgeon will try laparoscopic first) due to an obstruction in my sleeve, ulcers, and scar tissue buildup being 7+ years out, so my recovery may be a bit different/lengthy.

Edited August 17, 2019 by freetobeme

[catwoman7 11,215]

just wondering - do you have to make this decision soon? You could always sit on it for a few months if you need the time. You can stay on PPI's in the mean time. It sounds like you're not ready to take the plunge and have revision surgery, so maybe it'd be better to wait awhile until you're more confident of your decision (??)

[SeattleLady 277]

Some of us including me dumped with our sleeve. I did and will not easy fall into eating sugar. Dumping sucks!

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[KadieEuropeBound 11]

On 8/17/2019 at 3:17 PM, freetobeme said:

I'm sorry for all you have been going through. I also have a sliding haital hernia, by the way. Makes it possible to eat well some days and some other days, I can't get anything down. Since you had a hernia before the sleeve and it is back now, if repaired again without converting to the bypass, according to my surgery, the hernia will likely return in 3-5 years, unless your diaphragm is supported with a mesh filter. Making the decision to have any WLS is difficult enough, let alone having to decide on a revision. It really comes down to quality of life, from what I've experienced and heard in support group for months now. If you feel you can manage your reflux well enough with medication, then maybe surgery is not worth the risk but acid reflux could lead to other things down the line... In my case, there is a plethora of reasons for revision, so that in a way, has made it easier to decide (scheduled for 9/9/19). Also, regarding your main concern (dumping), I actually have that now with the sleeve (maybe 3-4 times a month). It happens when I make poor choices (high sugar or high fat). Yes, it's more likely to happen with the bypass, but I think managing our intake regardless of surgery type is key to preventing uncomfortable dumping situations.

I'll have surgery just 10 days before you, so if you'd like, let's keep in touch and I'll let you know how it goes! I am most likely to have an open surgery (surgeon will try laparoscopic first) due to an obstruction in my sleeve, ulcers, and scar tissue buildup being 7+ years out, so my recovery may be a bit different/lengthy.

@freetobeallofme, I would love to stay in touch of your progress with your revision to RnY. I don't know why I'm so nervous now. Maybe, the closer I get to the 9/19 revision date then the more I find more frighten possible complications that goes hand to hand with the gastric bypass.

My gerd is mild, per my latest upper GI. The pantoprazole 40 mg is suppressing my acid reflux for now. I'm still experiencing some mucus buildup in my throat and lump like feeling if I eat more than 4 oz of food or eating too fast.

4oz seems to be my sweet spot for comfort level and no gerd like symptoms. I use to be under the believe if I reach the 24 bmi; then my gerd goes away. However, I see some fit people posted on YouTube or othe wls boards still experiencing gerd. I have to lose 25 more pounds to be at a 24 bmi.

I'm blame myself for worrying about possible side effects of the gastric bypass. The dumping and reactive hypoglycemia. I worry too much about things that have not happened yet.

Up until June of this year, my gerd was not as pronounced. Not until an asthma/allergy attack put my acid reflux to being extremely bad while taking omeprazole. My doctor switched me pantoprazole and that medicine has controlled the daily acid reflux for now.

On top of all of this, I will be making a major relocation to Europe, moving to the county Netherlands. So I'm worrying about would the Dutch doctors know how to handle my new medical case if I should still proceed with the bypass.

My aunt had a revision from VSG to gastric bypass last year. She has no problems. She's happy. My aunt is super positive and do not let life worry her. I not at that level yet.

I still have time to decide if I need to continue with the revision. I pray that I have a sense of peace about this decision.

Thank you all for sharing your experiences with me and offering your kindness.

[catwoman7 11,215]

actually, bypass is pretty well known in Europe, so I wouldn't be particularly worried about that piece.

complications aren't very common, and when they do happen, they're almost always minor. I had a stricture when I was about a month out, which is an easy fix. I was told that it happens to about 5% of bypass patients, so it's considered the most common complication. I'd hardly call something that happens to 5% of patients "common", but there you go. Suffice it to say, complications just aren't all that common. You can also get Vitamin deficiencies, but those usually happen to people who aren't consistent with taking their Vitamins. The one exception to this is Iron deficiency. Some people just don't do well on oral iron and have to do infusions. But again, the vast majority of us do fine on oral iron supplements.

I guess you could call dumping a complication, but only about 30% of RNY patients dump. You can avoid it by not eating a lot of sugar at one sitting (which we shouldn't be eating *anyway*, so...)

I'm not sure what other complications you've heard of - but anything outside of what I mentioned are pretty rare.

[mlbdl 86]

I’m interested to know what you decided and how you are doing. I’m revising sleeve to bypass in November for GERD. I am aspirating acid into my lungs, so it has to be done. I’m on 2 GERD meds, I eat tums like candy, and 4 allergy meds for allergy symptoms (for instance, coughing up acid into my lungs) that the 2 Bariatric surgeons, ENT, and allergist all have concluded are made worse, if not mostly caused by, the GERD.

[KadieEuropeBound 11]

@mlbdl

I decided at this time to not revision to Gastric Bypass. My gerd started with bad eating and stress. I first needed to work on my eating and stress level.

My acid reflux is under control with a PPI. I still have little spikes of acid but I'm down to a Level 1 on a scale 1 to 10. I have been eating extremely slow and chewy my food completely. I cut out coffee and gerd triggered foods. It has helped 100%

I am giving myself until June 2020 that would put me at 3 years post op to see if the gerd has improved.

For me, diet changes and less stress have helped me. Another surgery, especially the bypass is major. I need to first exhausted all other options before undergoing the Gastric Bypass.

Let's stay in touch. I am praying for your surgery and help.

[JRT Mom 919]

KadieEuropeBound, you look great! I can only hope to look half as good as you do after my band to bypass!

You look young and that is in your favor right now for long term PPI usage. But there has been a lot of studies that suggests long term PPI usage can contribute to osteoporosis, and since many of us *ahem* more mature bariatric people have trouble getting enough Calcium in their diet we might be already be prone to osteoporosis to the PPI use could be troublesome.