Severe Gerd/esophogeal dysmotility. Revision vs nissen or just hernia repair?

[starladustangel 270]

I posted about this on the sleeve forum before. I developed GERD after my sleeve and was able to control it with one PPI a day until the end of 2020 where it's increased to two PPIs, 1 H2 and tums all day. Had issues with vomiting, nausea, stomach and chest pain. Difficulty swallowing. Sore throat since December.

Had an endoscopy 3/3. Lax LES causing GERD, gastritis and a nodule in the antrum of the stomach that appears to be benign but will be removed in an endoscopic ultrasound in June as a precaution as it has a small risk of turning cancerous later on. Gastroenterologist referred me to my bariatric surgeon believing revision is needed.

My surgeon wasn't sure on revision because I have lost all my excess weight with no regain. I have only been in maintenance for 4 months though. He sent me for a barium swallow.

Had the barium swallow and the radiologist found esophogeal dysmotility and a hernia that the endoscopy had missed. Radiologist said I will either need a nissen fundoplication or revision to bypass along with hernia repair

When I called my surgeon's office to schedule a follow up the nurse said something about maybe a hernia repair would be enough which left me feeling confused. I told her I want do whatever has the best chance of not having more complications or needing more surgery in the future. I had my galbladder out June 2020 after sleeve June 2019 and really just want to be healthy with no more surgery.

My follow up is on Tuesday. I am not sure what my surgeon is going to recommend. From posts here it seems nissen isn't the best option for sleeve patients. Would hernia repair be enough or is revision to bypass the best option? I just don't want to be getting hernia repair and then still have reflux be a problem due to my esophagus and end up needing a revision later on.

[GreenTealael 25,316]

15 hours ago, starladustangel said:

I posted about this on the sleeve forum before. I developed GERD after my sleeve and was able to control it with one PPI a day until the end of 2020 where it's increased to two PPIs, 1 H2 and tums all day. Had issues with vomiting, nausea, stomach and chest pain. Difficulty swallowing. Sore throat since December.

Had an endoscopy 3/3. Lax LES causing GERD, gastritis and a nodule in the antrum of the stomach that appears to be benign but will be removed in an endoscopic ultrasound in June as a precaution as it has a small risk of turning cancerous later on. Gastroenterologist referred me to my bariatric surgeon believing revision is needed.

My surgeon wasn't sure on revision because I have lost all my excess weight with no regain. I have only been in maintenance for 4 months though. He sent me for a barium swallow.

Had the barium swallow and the radiologist found esophogeal dysmotility and a hernia that the endoscopy had missed. Radiologist said I will either need a nissen fundoplication or revision to bypass along with hernia repair

When I called my surgeon's office to schedule a follow up the nurse said something about maybe a hernia repair would be enough which left me feeling confused. I told her I want do whatever has the best chance of not having more complications or needing more surgery in the future. I had my galbladder out June 2020 after sleeve June 2019 and really just want to be healthy with no more surgery.

My follow up is on Tuesday. I am not sure what my surgeon is going to recommend. From posts here it seems nissen isn't the best option for sleeve patients. Would hernia repair be enough or is revision to bypass the best option? I just don't want to be getting hernia repair and then still have reflux be a problem due to my esophagus and end up needing a revision later on.

(With all the due respects to nurses❤️) Unless the nurse received a message directly from the surgeon to give to you, that advice should be considered anecdotal. Your surgeon may see evidence from further testing that will swing the decision in a different direction. Wait to hear their advice.

Revisioners can maintain (and even gain) weight after being converted to RNY. Your surgeon may be able to help control how much extra you lose through planning a shorter bypass vs a longer one. That’s a question you may want to ask.

[starladustangel 270]

10 hours ago, GreenTealael said:

(With all the due respects to nurses❤️) Unless the nurse received a message directly from the surgeon to give to you, that advice should be considered anecdotal. Your surgeon may see evidence from further testing that will swing the decision in a different direction. Wait to hear their advice.

Revisioners can maintain (and even gain) weight after being converted to RNY. Your surgeon may be able to help control how much extra you lose through planning a shorter bypass vs a longer one. That’s a question you may want to ask.

My biggest fear is regain with all the talk from people about the lack of restriction they feel post vsg to rny revision. I would prefer to keep maintaining close to my current weight as it is a place I am happy with.

[HeatherE 201]

On 4/25/2021 at 7:29 PM, starladustangel said:

I posted about this on the sleeve forum before. I developed GERD after my sleeve and was able to control it with one PPI a day until the end of 2020 where it's increased to two PPIs, 1 H2 and tums all day. Had issues with vomiting, nausea, stomach and chest pain. Difficulty swallowing. Sore throat since December.

Had an endoscopy 3/3. Lax LES causing GERD, gastritis and a nodule in the antrum of the stomach that appears to be benign but will be removed in an endoscopic ultrasound in June as a precaution as it has a small risk of turning cancerous later on. Gastroenterologist referred me to my bariatric surgeon believing revision is needed.

My surgeon wasn't sure on revision because I have lost all my excess weight with no regain. I have only been in maintenance for 4 months though. He sent me for a barium swallow.

Had the barium swallow and the radiologist found esophogeal dysmotility and a hernia that the endoscopy had missed. Radiologist said I will either need a nissen fundoplication or revision to bypass along with hernia repair

When I called my surgeon's office to schedule a follow up the nurse said something about maybe a hernia repair would be enough which left me feeling confused. I told her I want do whatever has the best chance of not having more complications or needing more surgery in the future. I had my galbladder out June 2020 after sleeve June 2019 and really just want to be healthy with no more surgery.

My follow up is on Tuesday. I am not sure what my surgeon is going to recommend. From posts here it seems nissen isn't the best option for sleeve patients. Would hernia repair be enough or is revision to bypass the best option? I just don't want to be getting hernia repair and then still have reflux be a problem due to my esophagus and end up needing a revision later on.

You may want to get a second opinion from another bariatric surgeon. I very much trust my surgeon, but before I underwent surgery I got a second opinion from another practice to confirm I was doing the best surgery for my situation.

[GreenTealael 25,316]

38 minutes ago, starladustangel said:

My biggest fear is regain with all the talk from people about the lack of restriction they feel post vsg to rny revision. I would prefer to keep maintaining close to my current weight as it is a place I am happy with.

Regain is a legitimate fear. I stay careful but (not fixated) on what I eat and so far so good but obviously everyone’s experience will be different.

I still can get the tight chest VSG restriction if I eat drier Protein. Mostly I experience lower abdomen I’m bored with eating discomfort with RNY. With both I got the lump in my throat full feeling (does this happen to anyone else? IDK)

[starladustangel 270]

Had my appointment this morning. My surgeon is reccomending revision to RNY with hernia repair. He thinks I should likely maintain my weight as long as I keep watching what I eat and tracking my food.

[starladustangel 270]

My insurance finally approved my revision on Thursday. No issue getting approved. Insurance was just behind and super slow right now. Hopefully it gets to my surgeon's office quickly and I get a date soon.

[meressa 7]

How did it go?

[starladustangel 270]

On 6/2/2021 at 12:04 PM, meressa said:

How did it go?

My revision is scheduled for 7/13

[StratusPhr 127]

On 6/14/2021 at 8:45 AM, starladustangel said:

My revision is scheduled for 7/13

My first appointment for severe reflux after my 2010 VSG was last week. He recommended RNY, I had a endoscopy in Nov 2019. The gastrologist put me on a prescription PPI. It worked, I went from 8 - 10 Tums a day, EVERY day, to none. That lasted for two months then it started coming back. Dr had me up the dose to twice a day. That worked until three months ago. I'm back to needing to eat Tums almost daily. There's no rhyme or reason, I've cut back or out anything that I see recommended online, but the reflux bothers me after things that absolutely should not bother me, and it isn't consistent. Sometimes something will really get me, but the next time it won't, and vice versa. I hope the insurance will approve this. I was self pay with VSG, I can't do that again. This is medically necessary, so many it won't be turned down. Good luck!!! Keep us posted.

[Tracyringo 503]

On 6/14/2021 at 8:45 AM, starladustangel said:

My revision is scheduled for 7/13

Good luck on your revision.

I was one of those that was freaked out after having it done and having no restriction. It turns out this RNY was better for me with maintaining weight loss and I actually lost 25lbs more. Its crazy how it has all worked out and I am very happy other then I am still stuck on a PPI twice a day !!!!

[starladustangel 270]

3 days post op from revision and hiatal hernia repair. Way more pain this time than before. My surgeon said I could try a Protein Shake tomorrow but I am having pain eating a sugar free Jello. So far the best things have been sugar free Popsicles and twinings comfort tea with a little stevia. I am wearing a binder and using a cane to walk around the house due to the abdominal pain. I have not felt any gerd yet so hopefully it stays away.

[starladustangel 270]

One week post op. My weight has dropped far faster than I would like. Went from 144 the day of surgery to 136 today.

The Constipation is awful. Nothing works. I already struggled with constipation pre revision. I finally went a little with an enema.

I am nauseous, weak and tired. Getting fluids in but very few calories since shakes lead to queasiness.

I have run low fevers off and on since surgery.

[GreenTealael 25,316]

1 minute ago, starladustangel said:

One week post op. My weight has dropped far faster than I would like. Went from 144 the day of surgery to 136 today.

The constipation is awful. Nothing works. I already struggled with Constipation pre revision. I finally went a little with an enema.

I am nauseous, weak and tired. Getting fluids in but very few calories since shakes lead to queasiness.

I have run low fevers off and on since surgery.

I had absolutely terrible constipation post revision too! I also had an enema then stayed on laxatives for a long time, under the supervision of my surgeon of course.

(I was so afraid of constipation again that I think I stayed on them a lot longer than I should have. In fact I am finally lax free using a stool softener only when necessary. But I’m happy to report that the plumbing still works on it’s own 👍🏽)

Speedy Recovery!

[starladustangel 270]

6 hours ago, GreenTealael said:

I had absolutely terrible Constipation post revision too! I also had an enema then stayed on laxatives for a long time, under the supervision of my surgeon of course.

(I was so afraid of constipation again that I think I stayed on them a lot longer than I should have. In fact I am finally lax free using a stool softener only when necessary. But I’m happy to report that the plumbing still works on it’s own 👍🏽)

Speedy Recovery!

My surgeon suggested magnesium citrate and drinking coffee today when I called. Trying both currently. Mixed a Protein Shake with black iced coffee and had my husband pick me up some magnesium citrate at Walgreens. Maybe the caffeine will perk me up a bit too.