Large hiatal hernia discovered during gastric bypass surgery

[Vikingfanaz10 1]

I went in for gastric bypass surgery last Tuesday... actually a sleeve to bypass revision (had sleeve in 2010).

Long story short, once the surgeon had me opened up a very large hiatal hernia was discovered. She determined gastric bypass could not be performed safely at this point due to the extensive repair of my hiatal hernia.

She wants me to heal from the HH REPAIR surgery for 90 days, then do the sleeve to bypass revision.

Needless to say I'm pretty bummed out GP surgery wasnt done, but also glad the HH was fixed.

Has anyone else experienced this? Alot of mixed emotions, whether I should consult a different surgeon, or talk to an attorney.

[elcee 3,341]

I haven’t heard of surgery being delayed for that. I know that it is fairly common for hernias to be repaired at the same time as WLS. Mine was done during my band to bypass

[Panda333 276]

I don't know why you would consult an attorney or another surgeion unless you think malpractice was done. I think your surgeon did the correct course to fix your henia, then wait to do your revision...... I'm sure you signed your life away before the surgery as well.......

[LastChance57 35]

I agree with Panda333. Blood clots can also form and he’s probably waiting until you have healed first.

[AZhiker 2,252]

My HH was repaired at the same time as gastric bypass. However, If yours was large and extensive, I can see why the surgeon would delay the GB. Visualize a significant portion of your stomach up into your chest cavity - above the diaphram. This upper part of the stomach is what gets "pouched" and if trauma and swelling from the HH surgery prevented a good surgical approach to creating the new pouch, then by all means, delay GB until the first surgery is resolved. You sure don't want anything to compromise your "forever" pouch. My only question is that if the HH was really so big, why it wasn't detected with your preop endoscopy.

[RickM 1,747]

I think that second opinions are always a good idea, particularly when revisions are involved as both the cause, or need for the revision as well as the surgery itself tend to be more complex than the original virgin procedure, and this is where different perspectives are useful.

As with AZhiker above, my real question is why was the hernia a surprise? What kind of evaluation was done to determine that you need a revision, and that the RNY is the most appropriate course of action? Any kind of a problem with the sleeve, whether it be GERD or inadequate weight loss or regain - the most common problems - I would expect that an upper GI or EGD, or both, would be done to evaluate the condition of the sleeve and either would have shown the hernia.

With lapband revisons, we often see some patients get two-stepped - remove the band and allow time to heal, then do the revision to VSG or RNY, but just as often it is all done in one procedure. Is the difference specific to the individual patients' situation, or the surgeon's experience and skills? I don't know, but it seems analogous to your situation where it may be that your case is particularly complicated and any surgeon would two-step it, or that the hernia repair combined with the revision is beyond the surgeon's comfort zone and someone else could have done it in one shot.

What is the reason for your need for a revision? If it was for GERD, the hernia repair may well correct or improve it. Sometimes a simple resleeve can correct it if there are shaping issues with the sleeve (not uncommon with sleeves from early in the decade) though not all surgeons know how to do that.

If it is a regain problem, what has been done to address the issue non-surgically (diet or head games) as overall the RNY isn't really any better at controlling regain than the VSG, and if the fundamental problem isn't addressed, it will happen again. A re-sleeving may do as well, or a revision to the duodenal switch would be a stronger response to that problem.

Just more things to consider....(why can't things be easy?)

Good luck...

[Vikingfanaz10 1]

Thank you everyone. I'm starting to feel better. Just felt alot of frustration because I was waiting so long for bypass and now have to wait longer. With my initial sleeve op I went from 400lbs down to 290. I've slowly creeped up to 360 over the last 5 years. I've been diagnosed with barrett's esophagus so that was a big reason for the conversion along with regain

[GreenTealael 25,377]

Until surgery can be performed, Join us here for motivation and accountability

[Roserie 302]

My hiatal hernia was actually repaired during my revision from VSG to RNY. I was told aside from the GERD that this was the best way to repair my hernia.