9 months out-VSG Fundus Complications

[Cia2020 77]

I'm 9 months out from VSG, saw the bariatric clinic follow up staff, and am so GRR now. I never had that "I'm never hungry" feeling once I recovered from the surgery but shrugged it off. I could drink 2 oz. fluids at once literally the day of surgery so I was like... OK, cool. Weight loss was slow despite being diet compliant and exercising, stopped at 25 pounds after 3 months, then gained 10 back after a foot injury (off again since getting back to my daily 5k jog). I've been having reflux for ages despite avoiding trigger foods/drinks and I get hiccups 20+ times a day regardless of how I'm eating, drinking, or not doing either. So they referred me back to the surgeon's office.

Last week I had an upper GI study. The radiology report says I have mild decreased lower esophageal motility and mild outpouching at the fundus... um, I shouldn't HAVE a fundus after gastric sleeve. The weakened esophageal muscles explains the Fluid that backs up when I drink sometimes, especially if not sitting straight up or standing, and the chest lock I feel when eating dryer foods or meats. I'm confused about the fundus. Is the radiologist mistaken and unfamiliar with VSG anatomy? Did the surgeon leave part of my fundus? The surgeon's office is awful at communicating so I'm in limbo. They didn't even call me before ordering the upper GI, they just had the radiology department call to schedule me without notice.

All I can think about is where I go from here. Meds for the reflux and live with the hiccups? Revision surgery for the reflux and basically start over (the big GRR)? Anyone else have anything similar like a retained fundus, outpouching, or GERD with esophageal motility disorders like weakened muscles after VSG surgery?

[SleevedK 25]

My situation is a little different (GERD and hiatal hernia, but sleeve seems okay) but here is what I would suggest based on what I have learned trying to understand my problems.
It might be worth getting a second opinion from a surgeon in a different practice who is willing to look at your upper GI imaging and tell you if they think the sleeve looks properly shaped or not. I have been reading this doctor's webpage where he talks about how, in some cases, a misshapen gastric sleeve can aggravate GERD: https://houstonsleevesurgeon.com/category/acid-reflux-and-heartburn/

If you are having significant GERD, you should probably get on meds for that and see if that is enough to control it. When I was reading about this, I did see one study that talked about how, for some post-sleeve patients, the GERD gets better after about 3 years or so because your stomach becomes more "compliant' by that point (and then there is not as much pressure in the sleeve to push the acid up), so if the GERD is controllable with meds, you could try waiting it out and see if it gets better. If it doesn't get better, or if it is not responding to the meds. then you have to decide if you want to get an RNY, or if you want to try the Linx, or possibly ask your doctor about this new procedure I recently learned that some doctors are trying for those of us with sleeves who are having GERD: https://www.sciencedirect.com/science/article/abs/pii/S000296102030814X

Edited March 7, 2021 by SleevedK

[Starwarsandcupcakes 2,091]

I developed another hiatal hernia 3 months post VSG (had one repaired with my VSG. I then developed GERD, esophagitis, and hiccups. It was to the point that I was suffering with my work and sleeping.

The picture is from my Upper GI. The stricture from the hernia was so bad my surgeon faxed over approval paperwork the day he called me with the results. I ended up having to appeal it over the phone while hiccuping the entire call with the insurance company but ended up having revision with hernia repair surgery 3 weeks after my phone call to insurance at 8 months post VSG.

And technically while they remove most of the fundus you still have one even after VSG because it’s upper most part of the stomach connected to the esophagus farthest from the pyloric valve. Outpouching might be the beginnings of a hernia and coupled with the GERD might be what’s making the hiccups so bad.