Sage advice from a 14 year sleeve (VSG) vet.

[KateinMichigan 24]

I wanted to preface this post with this optimistic fact. My husband had the surgery with amazing results and no problems whatsoever 15 years ago - it saved his life. He lost over 150 pounds and kept if off. He's gained and lost the same 25 pounds like your typical middle aged person, but it's been nothing but a blessing for him. We had different surgeons.

My experience wasn't so awesome, and I feel it's so important to share a few facts so you choose the RIGHT surgeon and ask the RIGHT questions. I hope I can help people avoid the avoidable. I'm a big believer in the surgery - but I want you to not suffer. Let me help:)

What's the problem?

The sleeve has a common and serious side effect that I suffer with, and that many surgeons downplay. GERD. But this isn't the GERD you think you know - I'll jump into that later. GERD has up to a 30% rate of occurrence after VSG - that's a lot higher then what my doc told me. https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.14467. Not only did my doctor gloss over it, and convey that it was "really rare", but he didn't really explain what this type of GERD is. I'm going to explain what this type of GERD is, and then I'm going to arm you with the right questions and research to do before you pick a surgeon. Because once it goes bad, your surgeon will pawn you off on a GERD doctor and that's that. Let me help you get proactive and avoid a bad result!

What is VSG GERD?

Gastroesophageal reflux disease, or chronic acid reflux is when acid shoots into your esophagus and throat. VSG GERD is different - that's why I'm giving it its own name. I never had GERD before the surgery. Now I get VSG GERD after drinking 4 oz. of Water. It's NOT triggered by food. This isn't occasional, it's constant without dangerous meds. I now weigh 115 pounds, so it's not triggered by overindulgence or weight gain brought on by binging.

Now you might think you already know GERD. Who hasn't had to pop a tums here and there? Not a bad trade off for a morbid obesity cure, right? THIS IS NOT THAT!!!! VSG GERD is an unrelenting tidal wave of persistent, burning acid that causes chest pain (and emergency room visits) that can only be somewhat managed by daily, longterm use of a class of drugs called PPI's. These PPI's lead to malabsorption and a host of side effects. I sit in my local cancer center to have my bi-annual 4-hour Iron infusion with chemo patients to name just one. https://journals.lww.com/ajg/Fulltext/2018/10001/Effect_of_Long_Term_Proton_Pump_Inhibitor_Use_on.1227.aspx

PPI's are a class of drugs that are only intended for 2 weeks of use because of their fairly horrific side effects. PPI's are linked to depression, blindness, cancer, and early death, (and this is the short list). There are several law firms dedicated to compensation for PPI victims. PPI's makes me feel like I've just downed a bottle of mayo. I've been nauseous for years. I alternate between taking a bottle of tums a day so that I can take breaks from the PPI - but I always revert back to them after a short break to alleviate the pain. I am seriously at risk for a ton of really serious diseases, and my liver tests are really bad. PPI's are deadly. I'm in the process of finding a surgeon who can help.

https://www.nature.com/articles/s41598-019-53622-3

The amount of VSG patients converting to the bypass/Linx system/etc. to rid themself of GERD and get off PPI's is exploding. Common sense would tell you that this isn't a" tums" sort of reflux!

Hope for post VSG GERD

As someone with no energy, horrible anemia, and low final weight - the bypass conversion sounds like a disaster because of the increased risk of malabsorption, but one surgeon told me it might be my only option. Some surgeons are discovering that a revision surgery to treat a hiatal hernial (HH) is the key to relief. I've had several scopes over the years, and they can never find a HH, but according to my husband's VSG surgeon, that isn't uncommon. He feels there is a possibility that my past the doctors missing it. I'm waiting on my barium swallow results. This gives me hope - that's why I wanted to share it. Hope is everything. I'm also going to talk with the doctor who wrote this article. "Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy". Follow me and I'll keep you updated. https://www.americanjournalofsurgery.com/article/S0002-9610(20)30814-X/fulltext#gr2

Future VSG patients - ASK QUESTIONS!

A few surgeons are now doing the sleeve with hiatal hernia repair at the same time, and some understand how important it is to consider GERD while doing the surgery. Different surgeons have different techniques. Some doctors "get it", and are being proactive because they've seen the pain that GERD causes. Some downplay it. I would suggest that ALL sleeve pre op patients have this discussion with their surgeon before moving forward. If he downplays it, RUN.

ASK!!!! Ask your surgeon how many patients has he had who've had GERD. How does/or will he address it if you are unlucky? Ask about his follow up - does he even know what's going on with his past patients? How does he keep track? Has he sent any patients to a GERD specialist? If he says, "oh, only a few of my patients had that" - ask him how he handled it. (My surgeon sent me to the GERD doc and then cut off ties. He was not curious about my results - he did not want to know. He probably still tells patients that it is rare. He has no idea I've been suffering for 14 years.)

Bariatric surgeons who've done the surgery and are on the forefront of GERD repair are a good bet. These doctors are rare and you need to really hunt for them.

If your doctor does the whole "very rare", etc. (my doctor did), he's either: not reading recent studies, not listening to his patients, not following up on them, minimizing this horrific side effect, or all of the above. Don't settle for a doctor who acts like it's "super rare" or "no big deal". THIS IS A BIG DEAL. Find one that is proactive and discusses HOW they avoid it.

I'm rooting for all of you! Let's get the surgery, but let's get it from the right people. Don't pick the guy in Mexico just because he's cheap. Don't pick the guy because he takes your insurance. Spend the money for a few consults to discuss the surgery with different surgeons. Come here and reach out to people who've gone to him/her. I went with a blind recommendation and didn't ask enough questions - and the price is really expensive - I'm still paying.

[Creekimp13 5,840]

Great questions for your surgeon! Also, really great advice to look for surgeons with excellent credentials, excellent reputation, who can give examples of how they manage patients who develop GERD. It is an extremely important topic to research and ask good questions about....and also important that your surgeon has realistic good answers that gel with research. It is a common problem that sleeve patients need to take seriously.

Questions for surgeon... What steps do you take to prevent GERD? What strategies do you recommend for people who develop it? What percentage of your patients develop it? What do you do for them? Have you done continuing education on GERD management for sleeve patients? How has your approach to GERD changed in the years you've been doing sleeve surgeries?

I think this is a serious problem, and one I gave a lot of thought to.

That said....

I had a huge hiatal hernia before surgery, and terrible acid reflux.

My surgeon fixed the hernia when he did my sleeve and I have not had any acid since. Nada. Not one day...and it's been such a relief. Have often said that finding that rotten hernia and fixing it was one of the best things that ever happened to me. I'd have never looked for it if not for the sleeve surgery.

Experiences do vary...bigtime.

I appreciate your experience and think it's something folks need to be aware. Thank you so much for sharing it.

[WanderingHeart 141]

My sleeve surgery is on 4/6, I have not talked to the surgeon about this specifically. I typically don’t have digestive probs - only laying down shortly after eating certain foods. I don’t know if I have a hiatal hernia, is this something we can discuss and plan for on the day of?

[moonbean85 36]

Wow thanks so much for sharing your story. I had a small hernia that was discovered in preop testing. I wish I would have asked those questions or really ANY questions. I'm one month out of surgery lost about 45 pounds but feel terrible most days. Always tired and always hungry. Only had some wicked heart burn a few nights ago I just chalked it up to me moving from the pureed stage to solids. I so hope it gets better over time. I just figured I'm having a really slow recovery. Been taking famotidine for heart burn. It also happens if I dont eat anything. I will definitely bring more questions to my surgeon next visit.

Sent from my SM-G950U using BariatricPal mobile app

[ShoppGirl 4,785]

Wow. I’m so sorry you went through that but thanks for sharing your story to helP others. I had No idea it was different than ordinary heartburn when I had the surgery.

[mae7365 372]

As a recent sleeve to bypass patient - specifically to resolve the terrible GERD, Gastritis and Esophagitis caused by chronic acid reflux - I can so relate to your comments. I had acid reflux disease before I even had the sleeve, and my surgeon never told me that GERD could be a complication following sleeve surgery. In all fairness, I think that this has really only come to the surface over the past 5 years. Now surgeons, and GI doctors, seem to be more versed in GERD following sleeve surgery and more prone to advise patients to choose the bypass.

On a positive note, I've had ZERO acid reflux since my bypass surgery October 2020. I stopped taking any PPI, and my primary care doctor is thrilled. Long term use of PPI's can also lead to bone loss in women. Best decision I made was choosing the revision surgery.

[KateinMichigan 24]

Hi Wanderingheart. Absolutely reach out to your doctor and schedule a pre-op and ask the questions. If his answers are dismissive, I'd advise that you find someone else. I know that seems harsh. You've been waiting for this day! But believe me, waiting a few extra months for the right surgeon is better than suffering for years.

[KateinMichigan 24]

9 hours ago, KateinMichigan said:

I wanted to preface this post with this optimistic fact. My husband had the surgery with amazing results and no problems whatsoever 15 years ago - it saved his life. He lost over 150 pounds and kept if off. He's gained and lost the same 25 pounds like your typical middle aged person, but it's been nothing but a blessing for him. We had different surgeons.

My experience wasn't so awesome, and I feel it's so important to share a few facts so you choose the RIGHT surgeon and ask the RIGHT questions. I hope I can help people avoid the avoidable. I'm a big believer in the surgery - but I want you to not suffer. Let me help:)

What's the problem?

The sleeve has a common and serious side effect that I suffer with, and that many surgeons downplay. GERD. But this isn't the GERD you think you know - I'll jump into that later. GERD has up to a 30% rate of occurrence after VSG - that's a lot higher then what my doc told me.

https://pubmed.ncbi.nlm.nih.gov/31911216/

https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.14467.

Not only did my doctor gloss over it, and convey that it was "really rare", but he didn't really explain what this type of GERD is. I'm going to explain what this type of GERD is, and then I'm going to arm you with the right questions and research to do before you pick a surgeon. Because once it goes bad, your surgeon will pawn you off on a GERD doctor and that's that. Let me help you get proactive and avoid a bad result!

What is VSG GERD?

Gastroesophageal reflux disease, or chronic acid reflux is when acid shoots into your esophagus and throat. VSG GERD is different - that's why I'm giving it its own name. I never had GERD before the surgery. Now I get VSG GERD after drinking 4 oz. of Water. It's NOT triggered by food. This isn't occasional, it's constant without dangerous meds. I now weigh 115 pounds, so it's not triggered by overindulgence or weight gain brought on by binging.

Now you might think you already know GERD. Who hasn't had to pop a tums here and there? Not a bad trade off for a morbid obesity cure, right? THIS IS NOT THAT!!!! VSG GERD is an unrelenting tidal wave of persistent, burning acid that causes chest pain (and emergency room visits) that can only be somewhat managed by daily, longterm use of a class of drugs called PPI's. These PPI's lead to malabsorption and a host of side effects. I sit in my local cancer center to have my bi-annual 4-hour Iron infusion with chemo patients to name just one. https://journals.lww.com/ajg/Fulltext/2018/10001/Effect_of_Long_Term_Proton_Pump_Inhibitor_Use_on.1227.aspx

PPI's are a class of drugs that are only intended for 2 weeks of use because of their fairly horrific side effects. PPI's are linked to depression, blindness, cancer, and early death, (and this is the short list). There are several law firms dedicated to compensation for PPI victims. PPI's makes me feel like I've just downed a bottle of mayo. I've been nauseous for years. I alternate between taking a bottle of tums a day so that I can take breaks from the PPI - but I always revert back to them after a short break to alleviate the pain. I am seriously at risk for a ton of really serious diseases, and my liver tests are really bad. PPI's are deadly. I'm in the process of finding a surgeon who can help.

https://www.nature.com/articles/s41598-019-53622-3

The amount of VSG patients converting to the bypass/Linx system/etc. to rid themself of GERD and get off PPI's is exploding. Common sense would tell you that this isn't a" tums" sort of reflux!

Hope for post VSG GERD

As someone with no energy, horrible anemia, and low final weight - the bypass conversion sounds like a disaster because of the increased risk of malabsorption, but one surgeon told me it might be my only option. Some surgeons are discovering that a revision surgery to treat a hiatal hernial (HH) is the key to relief. I've had several scopes over the years, and they can never find a HH, but according to my husband's VSG surgeon, that isn't uncommon. He feels there is a possibility that my past the doctors missing it. I'm waiting on my barium swallow results. This gives me hope - that's why I wanted to share it. Hope is everything. I'm also going to talk with the doctor who wrote this article. "Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy". Follow me and I'll keep you updated. https://www.americanjournalofsurgery.com/article/S0002-9610(20)30814-X/fulltext#gr2

Future VSG patients - ASK QUESTIONS!

A few surgeons are now doing the sleeve with hiatal hernia repair at the same time, and some understand how important it is to consider GERD while doing the surgery. Different surgeons have different techniques. Some doctors "get it", and are being proactive because they've seen the pain that GERD causes. Some downplay it. I would suggest that ALL sleeve pre op patients have this discussion with their surgeon before moving forward. If he downplays it, RUN.

ASK!!!! Ask your surgeon how many patients has he had who've had GERD. How does/or will he address it if you are unlucky? Ask about his follow up - does he even know what's going on with his past patients? How does he keep track? Has he sent any patients to a GERD specialist? If he says, "oh, only a few of my patients had that" - ask him how he handled it. (My surgeon sent me to the GERD doc and then cut off ties. He was not curious about my results - he did not want to know. He probably still tells patients that it is rare. He has no idea I've been suffering for 14 years.)

Bariatric surgeons who've done the surgery and are on the forefront of GERD repair are a good bet. These doctors are rare and you need to really hunt for them.

If your doctor does the whole "very rare", etc. (my doctor did), he's either: not reading recent studies, not listening to his patients, not following up on them, minimizing this horrific side effect, or all of the above. Don't settle for a doctor who acts like it's "super rare" or "no big deal". THIS IS A BIG DEAL. Find one that is proactive and discusses HOW they avoid it.

I'm rooting for all of you! Let's get the surgery, but let's get it from the right people. Don't pick the guy in Mexico just because he's cheap. Don't pick the guy because he takes your insurance. Spend the money for a few consults to discuss the surgery with different surgeons. Come here and reach out to people who've gone to him/her. I went with a blind recommendation and didn't ask enough questions - and the price is really expensive - I'm still paying.

Found this too:

https://pubmed.ncbi.nlm.nih.gov/33483233/

Edited March 26, 2021 by KateinMichigan

[SleevedK 25]

Thank you for bringing attention to this issue. People who haven't lived with significant GERD often don't understand how serious it can be and how it affects quality of life. We need to find solutions to this problem. Now that so many people have gotten the sleeve, there will be an explosion of people affected by the nasty form of GERD that can happen post-sleeve, and not all of them are good candidates for the bypass. I feel like doctors push people to convert to bypass whenever there is an issue with the sleeve because that is something they are familiar with and has fairly predictable complications. However, I have seen so many stories of people who converted to bypass but then ended up with new problems or still had reflux even then.
There has to be a better way to deal with this problem.

Can I ask, how have you managed to cope with the awful GERD all this time? What do you do in order to get through the day? Have you developed Barrett's esophagus?

Edited March 28, 2021 by SleevedK

[KateinMichigan 24]

On 3/27/2021 at 9:58 PM, SleevedK said:

Thank you for bringing attention to this issue. People who haven't lived with significant GERD often don't understand how serious it can be and how it affects quality of life. We need to find solutions to this problem. Now that so many people have gotten the sleeve, there will be an explosion of people affected by the nasty form of GERD that can happen post-sleeve, and not all of them are good candidates for the bypass. I feel like doctors push people to convert to bypass whenever there is an issue with the sleeve because that is something they are familiar with and has fairly predictable complications. However, I have seen so many stories of people who converted to bypass but then ended up with new problems or still had reflux even then.
There has to be a better way to deal with this problem.

Can I ask, how have you managed to cope with the awful GERD all this time? What do you do in order to get through the day? Have you developed Barrett's esophagus?

It’s been a dance. PPI’s for a few weeks, then Pepcid and Tums, then eating window of 1-5 / Protein only/ with tums. No sugar 95% of the time. Carbs and sugar hurt 😞 - below if from my diary on day three of going off PPI’s yesterday. I had to take 4 tums throughout last night - kept waking up with GERD. The mug has homemade chowder - 3 tablespoons. The greens are avo and cucumber. Gotta avoid hot Tea at night...Have not been diagnosed with Barrett’s yet.

Edited March 29, 2021 by KateinMichigan

[KateinMichigan 24]

https://www.sages.org/meetings/annual-meeting/abstracts-archive/laparoscopic-repair-of-hiatal-hernia-with-dor-fundoplication-after-sleeve-gastrectomy-in-a-patient-with-intractable-gerd-and-retained-gastric-body/

[Abbie_tom 0]

I’m now 9 months post op and down 90lbs. I was told that my GERD would subside about a month after surgery. It has not. They just did an X-ray and found a hiatal hernia and severe esophagus reflux. I’ve not spoken with my doctor yet (just read the results) but is there a fix for this? I did not have the hernia prior to surgery (was checked 4 times).

[mae7365 372]

3 hours ago, Abbie_tom said:

I’m now 9 months post op and down 90lbs. I was told that my GERD would subside about a month after surgery. It has not. They just did an X-ray and found a hiatal hernia and severe esophagus reflux. I’ve not spoken with my doctor yet (just read the results) but is there a fix for this? I did not have the hernia prior to surgery (was checked 4 times).

My GERD just got worse with time after my VSG in November 2015. After all the diagnostic tests were positive, I had a bypass done in October 2020 to resolve GERD, Gastritis and Esophagitis that no longer responded to medication. I have not had one episode of GERD or heartburn since. The results have been remarkable nd I'm so glad I had the surgery.

[SleevedK 25]

3 hours ago, Abbie_tom said:

I’m now 9 months post op and down 90lbs. I was told that my GERD would subside about a month after surgery. It has not. They just did an X-ray and found a hiatal hernia and severe esophagus reflux. I’ve not spoken with my doctor yet (just read the results) but is there a fix for this? I did not have the hernia prior to surgery (was checked 4 times).

I am sorry you are dealing with this. It is an awful problem. A lot of surgeons will tell you to convert to bypass for bad reflux and a hiatal hernia, but you can try fixing the hiatal hernia and see if that works. For some people, just fixing the hiatal hernia is enough to help the reflux. Since most of our stomach is gone, we can't have a Nissen fundoplication (the usual procedure to fix a hiatal hernia and control acid) but they can still just pull the stomach down into your abdomen and stitch the diaphragm closed. The main reason that is not always their first choice is because that may have a higher failure rate. Another option if your esophagus is strong enough for it would be to get a Linx device, since that seems to help keep hiatal hernias from coming back too.