Have you had the “Hiatal Hernia Surprise” Fix?

[KateinMichigan 24]

In recent years I’ve noticed a spike in the “Hiatal Hernia Surprise surgery” stories shared on the forums. That’s when you wake up to your surgeon telling you he fixed a “surprise hernia” while doing your sleeve. What gives?

My 15 years of suffering with GERD after VGS, (I never ate a Tums before sleeve) has lead me to extensive research on this topic. I’ve read ever medical paper, report, blog I can get my hands on. I’ve met with and spoken to MANY surgeons on this subject.

THEORY ABOUT “THE SURPRISE”

I have a sneaking suspicion that the sleeve surgery itself leads to a hernia in many patients. (See stats about De Novo GERD and VGS).

The new stomach is lighter and thinner, with more internal pressure and can now easily slide into the esophageal area past the diaphragm to create a HH because the new shape allows it to.

I wonder if VSG surgeon don’t want to scare patients with the stats (30-40% chance of GERD without HH repair), so they just throw in the “hernia surgery surprise” to skirt the conversation.

if this happened to you, please share the details- so many would benefit from your story. Knowledge is power!

For those who haven’t had it yet - have the convo with your surgeon- let’s eliminate the “surprise”.

I’m also sharing my journey to find a solution for those currently suffering from GERD after VSG.

Not sure why post VLS GERD is still the “Wild West”. So many different opinions on how to fix it - sheesh.

What I’ve been told to do by different surgeons over the years, and what I’ve learned:

1) “convert to rny”

This was an instant turn off, but I get why so many do it. The pain is that bad for some.

A seasoned WL surgeon recently told me the conversion to RNY is problematic long term (yet many still recommend it). He doesn’t do it anymore. He’s fixed hundreds of these HH post sleeve with a basic HH repair, no- and only had to covert 1 stubborn case.

He said the conversion often leads to gas, malabsorption, vomiting, exhaustion, nausea, with many converts still ending up with GERD!

If you’ve had the conversion and are a few years out - please share your experience.

2) “go with a partial wrap”

This particular Doc said he’d “figure out what was best to do once he was in there.” I lost all confidence in him with that last statement, but I didn’t even realize this was a possibility if your fundus has expanded.

3) “get the LINX”

I’m allergic to fake metals (I get hives), yet this particular surgeon was ready to slap this metal puppy around my esophagus. Luckily, the maker ( J&J) posted a warning on their site for sensitive skin types: “do NOT, under any circumstances, put this in your body”.

I might have considered it if I didn’t have the allergy, although it seems very problematic for some.

4) “get the ligamentum procedure with repair”

This is an old surgery for GERD that involves using your internal umbilical cord. Because it’s so new for WLS GERD, I asked the surgeon if one of his success stories could call me. He obliged. A very sweet women called me, and went on and on about how great the surgeon was. But then she told me she was still on PPI’s and now had chronic diarrhea and dumping syndrome…sooo…back to the drawing board.

5) “Get the basic HH repair”.

I’ve consulted with 3 seasoned WLS surgeons who are all on the same page (finally). These 3 say that they pull my stomach back into the right spot, tighten the diaphragm, and call it a day. One uses mesh, but the other 2 sited a recent research paper saying there is no advantage to mesh.

They all said I’d have a 80-90% chance of being able to go off the PPI’s. Sorta a fantasy promise- but I’m liking those odds.

Of course I’ve done my research and discovered the fail rate over the long term is high (30-40%) after 10 years. and I might have minor swallowing problems, and bloating- yea! But I can have it adjusted if it gets bad, so that’s reassuring.

So I’m going in with my eyes wide opened and doing the basic repair, I hope it works. The recovery is long and difficult, but my alternative is PPI’s that are cancerous.

Wish me luck and thanks for reading my rant:) I hope it helped a few of my Gerdy sisters, and if you’ve had the “surprise”, please share your experience!

[Creekimp13 5,840]

My Hiatal Hernia was NOT a surprise. I'd seen imaging and was told up front that it needed to be fixed. It was likely the result of a bad fall off a horse a few years back.

[Jaelzion 1,127]

Mine wasn't a surprise. It was identified before surgery during the required endoscopy. My surgeon told me he was going to address it while doing my sleeve.

[lizonaplane 1,612]

I haven't had surgery yet but my doc said he'd fix any HH if he saw one when he operates. He said that's why he doesn't need to do EGD first. I am not thrilled about that, but that's what he wants to do.

[KateinMichigan 24]

So glad to hear many are being told upfront about the HH surgery with sleeve. Did you all know this in advance? (Already had gerd), or did they find it pre op?

Recently read a new study that found a 50% increase in HH repair during Sleeve vs. bypass…so it’s obvious docs understand sleeve carries higher risk of GERD from HH than bypass.

[KateinMichigan 24]

On 7/14/2021 at 10:59 PM, Creekimp13 said:

My Hiatal Hernia was NOT a surprise. I'd seen imaging and was told up front that it needed to be fixed. It was likely the result of a bad fall off a horse a few years back.

Hi Creekimp,

I noticed you had the HH repair with your sleeve - brilliant. I also noticed you had no reflux. The reason you might have skirted reflux is because your surgeon addressed this. (Many still don’t). Do you know how big your hernia was? Did you have any signs the you had a HH before surgery such as reflux? How was the recovery?

I’m Going in for a post HH repair because of de novo GERD, but hardly anyone in here talks about the actual HH part of it. Did you feel any tightness around you esophagus? Swallowing issues? Any feedback would be greatly appreciated!

Edited July 17, 2021 by KateinMichigan

[Ready21 34]

Yep…just this past Thursday. After the doc came to visit me in recovery he said that I had a HH near my esophagus that they “saw” and repaired

[KateinMichigan 24]

10 hours ago, Ready21 said:

Yep…just this past Thursday. After the doc came to visit me in recovery he said that I had a HH near my esophagus that they “saw” and repaired

Be glad that it was addressed! Wow - you’re on day 3! How are you feeling? I hear the HH repair is the bulk of the pain…don’t worry, it’s gets way better. If you get a chance to share your recovery steps, I’d appreciate it. I’m going into the HH repair soon and would love to hear what that’s like.

Edited July 18, 2021 by KateinMichigan

[SleevedK 25]

On 7/14/2021 at 8:40 PM, KateinMichigan said:

In recent years I’ve noticed a spike in the “Hiatal Hernia Surprise surgery” stories shared on the forums. That’s when you wake up to your surgeon telling you he fixed a “surprise hernia” while doing your sleeve. What gives?

My 15 years of suffering with GERD after VGS, (I never ate a Tums before sleeve) has lead me to extensive research on this topic. I’ve read ever medical paper, report, blog I can get my hands on. I’ve met with and spoken to MANY surgeons on this subject.

THEORY ABOUT “THE SURPRISE”

I have a sneaking suspicion that the sleeve surgery itself leads to a hernia in many patients. (See stats about De Novo GERD and VGS).

The new stomach is lighter and thinner, with more internal pressure and can now easily slide into the esophageal area past the diaphragm to create a HH because the new shape allows it to.

I wonder if VSG surgeon don’t want to scare patients with the stats (30-40% chance of GERD without HH repair), so they just throw in the “hernia surgery surprise” to skirt the conversation.

if this happened to you, please share the details- so many would benefit from your story. Knowledge is power!

For those who haven’t had it yet - have the convo with your surgeon- let’s eliminate the “surprise”.

I’m also sharing my journey to find a solution for those currently suffering from GERD after VSG.

Not sure why post VLS GERD is still the “Wild West”. So many different opinions on how to fix it - sheesh.

What I’ve been told to do by different surgeons over the years, and what I’ve learned:

1) “convert to rny”

This was an instant turn off, but I get why so many do it. The pain is that bad for some.

A seasoned WL surgeon recently told me the conversion to RNY is problematic long term (yet many still recommend it). He doesn’t do it anymore. He’s fixed hundreds of these HH post sleeve with a basic HH repair, no- and only had to covert 1 stubborn case.

He said the conversion often leads to gas, malabsorption, vomiting, exhaustion, nausea, with many converts still ending up with GERD!

If you’ve had the conversion and are a few years out - please share your experience.

2) “go with a partial wrap”

This particular Doc said he’d “figure out what was best to do once he was in there.” I lost all confidence in him with that last statement, but I didn’t even realize this was a possibility if your fundus has expanded.

3) “get the LINX”

I’m allergic to fake metals (I get hives), yet this particular surgeon was ready to slap this metal puppy around my esophagus. Luckily, the maker ( J&J) posted a warning on their site for sensitive skin types: “do NOT, under any circumstances, put this in your body”.

I might have considered it if I didn’t have the allergy, although it seems very problematic for some.

4) “get the ligamentum procedure with repair”

This is an old surgery for GERD that involves using your internal umbilical cord. Because it’s so new for WLS GERD, I asked the surgeon if one of his success stories could call me. He obliged. A very sweet women called me, and went on and on about how great the surgeon was. But then she told me she was still on PPI’s and now had chronic diarrhea and dumping syndrome…sooo…back to the drawing board.

5) “Get the basic HH repair”.

I’ve consulted with 3 seasoned WLS surgeons who are all on the same page (finally). These 3 say that they pull my stomach back into the right spot, tighten the diaphragm, and call it a day. One uses mesh, but the other 2 sited a recent research paper saying there is no advantage to mesh.

They all said I’d have a 80-90% chance of being able to go off the PPI’s. Sorta a fantasy promise- but I’m liking those odds.

Of course I’ve done my research and discovered the fail rate over the long term is high (30-40%) after 10 years. and I might have minor swallowing problems, and bloating- yea! But I can have it adjusted if it gets bad, so that’s reassuring.

So I’m going in with my eyes wide opened and doing the basic repair, I hope it works. The recovery is long and difficult, but my alternative is PPI’s that are cancerous.

Wish me luck and thanks for reading my rant:) I hope it helped a few of my Gerdy sisters, and if you’ve had the “surprise”, please share your experience!

Thank you so much for the summary of what you heard from the surgeons. This is actually the first time that I have heard a surgeon has noticed a trend of long term problems from sleeves revising to RNY. Thank you for making me aware of this. Sometimes I have wondered if I should do the revision to RNY since it is supposed to be the most reliable fix to this issue (and so many doctors push it as the best solution), but I definitely do not want to create new problems for myself. The other thing that scares me about the RNY is: if it doesn't go well, then what do you do?!

Interesting that you got to talk to someone who had the ligamentum teres repair. Based on what I have learned in researching the Linx, I would wonder if her problems with diarrhea and dumping syndrome might mean that the ligamentum teres repair is pushing on her vagus nerve. The vagus nerve runs along the esophagus and stomach, and when the vagus nerve gets irritated, it can cause symptoms like that. I have seen people talk about how sometimes the Linx can cause vagus nerve issues, but never knew that could be a problem with the LT procedure too. Good to know.

I think that an 80-90% chance of getting off PPIs with just a basic hernia repair sounds amazing. Do you mind telling me who the surgeons who said that are? Even if the repair doesn't last forever, maybe if you can get a few years of relief, there will be a better solution later on down the road.

[Creekimp13 5,840]

On 7/17/2021 at 6:01 PM, KateinMichigan said:

Hi Creekimp,

I noticed you had the HH repair with your sleeve - brilliant. I also noticed you had no reflux. The reason you might have skirted reflux is because your surgeon addressed this. (Many still don’t). Do you know how big your hernia was? Did you have any signs the you had a HH before surgery such as reflux? How was the recovery?

My group does an upper GI routinely which diagnosed it, along with contrast imaging. My hernia was BIG. Surgeon said it was one of the biggest he's fixed and that half my stomach was likely living in my chest for a long time. I didn't have bad reflux, but I felt smothered when I laid down and probably had sleep apnea that wasn't diagnosed, which I attributed to being fat. I did have the occasional nasty episode of acid, but had no idea the hernia was so pronounced.

My recovery was extremely easy. I was up and walking the halls within a few hours of my surgery and had no problems drinking all I was allowed. (my group does the little medicine cups...one ounce, four times an hour...teenie little sips, but it worked great.) I had zero nausea. No vomiting or retching.

I DID have quite a bit of pain in my shoulder. Many people are convinced this is gas, but my surgeon explained it can be referred pain from your diaphragm. Since my diaphragm was messed with more than most folks and I experienced this pretty acutely, I'm betting on the referred pain hypothosis. Weirdly, putting an ice pack on my shoulder seemed to help quite a bit.

The opening in my diaphragm might have torn or stretched in a bad fall I took off a horse. Because it was likely caused by trauma, I didn't have issues with my esophogeal sphincter that people sometimes do that causes GERD...I just had my stomach squishing up into my thoracic cavity because trauma tore a bigger hole.

Sealing it up did the trick. Everything works great now. No acid. I can breathe great laying down. No sleep apnea.

[KateinMichigan 24]

1 hour ago, Creekimp13 said:

My group does an upper GI routinely which diagnosed it, along with contrast imaging. My hernia was BIG. Surgeon said it was one of the biggest he's fixed and that half my stomach was likely living in my chest for a long time. I didn't have bad reflux, but I felt smothered when I laid down and probably had sleep apnea that wasn't diagnosed, which I attributed to being fat. I did have the occasional nasty episode of acid, but had no idea the hernia was so pronounced.

My recovery was extremely easy. I was up and walking the halls within a few hours of my surgery and had no problems drinking all I was allowed. (my group does the little medicine cups...one ounce, four times an hour...teenie little sips, but it worked great.) I had zero nausea. No vomiting or retching.

I DID have quite a bit of pain in my shoulder. Many people are convinced this is gas, but my surgeon explained it can be referred pain from your diaphragm. Since my diaphragm was messed with more than most folks and I experienced this pretty acutely, I'm betting on the referred pain hypothosis. Weirdly, putting an ice pack on my shoulder seemed to help quite a bit.

The opening in my diaphragm might have torn or stretched in a bad fall I took off a horse. Because it was likely caused by trauma, I didn't have issues with my esophogeal sphincter that people sometimes do that causes GERD...I just had my stomach squishing up into my thoracic cavity because trauma tore a bigger hole.

Sealing it up did the trick. Everything works great now. No acid. I can breathe great laying down. No sleep apnea.

Thank you for the detailed reply! You are such a success story and it’s so helpful for people to be able to read different experiences.

I’m really curious about your fall. My surgeon told me today that “the bigger the hernia, the less weight loss success”, which made me wonder if hernia and weight gain go hand in hand. Did you have weight issues before your accident?

Edited July 20, 2021 by KateinMichigan

[jasj65 9]

Had my HH fixed as well and I really have done well. 6th of July was my surgery and dr noticed it in the OR and fixed. Happy with it too !

[Creekimp13 5,840]

On 7/20/2021 at 5:36 PM, KateinMichigan said:

I’m really curious about your fall. My surgeon told me today that “the bigger the hernia, the less weight loss success”, which made me wonder if hernia and weight gain go hand in hand. Did you have weight issues before your accident?

Yes, I was about 250 pounds when my horse refused a jump and I sailed off, flipped end for end....and landed like a sack of potatoes with a massive thud. Had the wind knocked out, a concussion, shock, the works. Very tall draft-horse cross. Ouch!

When your doctor described that coorelation, he might have been talking about people who develop hiatal hernia from chronic overeating....already having behaviors that are difficult to change. And this might have been a *part* of why my diaphragm gave up...because perhaps I'd weakened it with chronic overeating....BUT, the extent of my hernia was much more likely to have been caused more by the trauma.

You CAN give yourself hiatal hernia from chronically overeating. It makes perfect sense that if you routinely continue to eat past an uncomtortable "full" sensation, that might coorelate with reduced success.

[LouLouM 70]

I haven't had weight loss surgery yet, but one of the requirements before surgery was to have an upper endoscopy. I had that last week and during it they found a hiatal hernia.

[SleevedK 25]

KateInMichigan, have you had your hernia repair surgery yet? I hope it went well if so. If you're still waiting, hope things move along soon!