Revision from VSG to RNY with hernia repair

[shriner37 249]

I was sleeved in September of 2015. Weight loss was moderately successful with some regain. High weight was 300, surgery weight 277, got down to 210 and I'm currently at 233. Goal was 185.

I have had some issues with GERD like others. Recently though my hiatal hernia has worsened and I am only able to eat very small amounts of food at any given meal. It seems like I'm back to eating like I did 6-8 weeks after my initial surgery.

I reached out to my bariatric surgeon and have scheduled an EGD for next week. From what his PA told me if they do a hernia repair they will want to do a revision to RNY at the same time. He said they do this in most all cases. I was also told that their practice (a high volume bariatric surgery facility) does 80-90% RNY these days with very few sleeves.

I've noticed that my type 2 diabetes was initially resolved by the sleeve surgery but my A1C has crept back up to 6.0 and my fasting glucose teeters right around 100. I wonder if the revision will resolve the metabolic issues as well as perhaps helping me lose another 20 pounds or so.

Does anyone have any insight into the reasoning behind doing the revision with the hernia repair?

[GradyCat 3,695]

I see this a lot on here with GERD after sleeve. It hasn't happened to me . . . yet. I'm wondering why that's a known issue, what causes it? I had GERD pre-WLS and now I don't have it since losing weight.

Can I be nosy? If the revision is to correct GERD caused by VSG, does it cost you anything/does insurance cover it?

[catwoman7 11,212]

3 hours ago, GradyCat said:

I see this a lot on here with GERD after sleeve. It hasn't happened to me . . . yet. I'm wondering why that's a known issue, what causes it? I had GERD pre-WLS and now I don't have it since losing weight.

Can I be nosy? If the revision is to correct GERD caused by VSG, does it cost you anything/does insurance cover it?

I've read it's because sleeve surgery can cause high-volume pressure on your remaining stomach, whatever that means.

and OP - yes, from what I've heard, the revision can resolve type 2 diabetes and you can lose another 20 lbs or so (most people do lose 20-30 lbs after revision - although some have lost more than that)

[shriner37 249]

3 hours ago, GradyCat said:

Can I be nosy? If the revision is to correct GERD caused by VSG, does it cost you anything/does insurance cover it?

I don't know. In 2015 I was self pay as my company insurance didn't cover bariatric surgery. I'm now retired and the ACA plan I have also doesn't cover anything related to bariatric surgery so if GERD was a side effect of the first surgery they wouldn't likely cover it. I think they will cover the hernia repair but not the bypass, so there might be some partial coverage.

Edited February 2, 2022 by shriner37

[Mo'Nique 7]

Happened to me after VBG I 2004. 12-03-2021 I had a revision to RNY do to complications with Gerd hernias and me closed esophagus. They did not repair hernias. I've lost 40lbs and can barely feel either hernia anymore and can eat without issues!

[southernbanded 4]

This is very interesting and is a current issue that I have been battling for two years to have covered by my insurance company.

I had lab-band done in 2013. Starting weight was 317 and got down to 222 pounds. However, I suffered from extreme acid reflux, causing me to sleep sitting up for three years. I was vomiting acid and sick every meal. When I spoke to my doctor about this, he immediately suggested conversion to VSG. While awaiting the approval for the VSG conversion, they made me do it in two parts. One surgery to remove the band, wait six months for the stomach to reshape itself, and then complete the VSG surgery. I gained 50 pounds back of my lost weight. I had the conversion done in December 2016. Everything went well. Acid was gone. However, I never felt restricted at all. I never really lost weight.

Fast forward one year to 2017, and the acid returned. In 2019, after having severe complications from acid reflux and developing a nightly cough, I called my doctor only to find out that he had passed away. I decided to see an upper GI doctor who did an EGD and found me with Hernia, GERD, and Esophagus damage. He sent me to a surgeon specializing in throat cancer and bariatric issues. Submitted to have surgery was denied.

We have been battling this for almost two years. I went this past week to another bariatric doctor familiar with my deceased doctor's work and also completed an EGD himself on me this past Monday. Same thing, Hernia, GERD, and now they believe I have Barretts Esophagus. They submitted to the insurance to repair and again denied. Insurance says these complications came from bariatric surgery and did not cover even if medically necessary; My new doctor is also a lawyer (go figure); he is completing a peer-to-peer next week to try to have them complete the repair one final time. If approved, I will only need to pay for the bypass conversion. So fingers crossed. I feel as if my insurance company would rather me die of esophagus cancer than keep me from dying from cancer. It is truly sad.

[shriner37 249]

On 2/4/2022 at 12:43 PM, southernbanded said:

This is very interesting and is a current issue that I have been battling for two years to have covered by my insurance company.

I had lab-band done in 2013. Starting weight was 317 and got down to 222 pounds. However, I suffered from extreme acid reflux, causing me to sleep sitting up for three years. I was vomiting acid and sick every meal. When I spoke to my doctor about this, he immediately suggested conversion to VSG. While awaiting the approval for the VSG conversion, they made me do it in two parts. One surgery to remove the band, wait six months for the stomach to reshape itself, and then complete the VSG surgery. I gained 50 pounds back of my lost weight. I had the conversion done in December 2016. Everything went well. Acid was gone. However, I never felt restricted at all. I never really lost weight.

Fast forward one year to 2017, and the acid returned. In 2019, after having severe complications from acid reflux and developing a nightly cough, I called my doctor only to find out that he had passed away. I decided to see an upper GI doctor who did an EGD and found me with Hernia, GERD, and Esophagus damage. He sent me to a surgeon specializing in throat cancer and bariatric issues. Submitted to have surgery was denied.

We have been battling this for almost two years. I went this past week to another bariatric doctor familiar with my deceased doctor's work and also completed an EGD himself on me this past Monday. Same thing, Hernia, GERD, and now they believe I have Barretts Esophagus. They submitted to the insurance to repair and again denied. Insurance says these complications came from bariatric surgery and did not cover even if medically necessary; My new doctor is also a lawyer (go figure); he is completing a peer-to-peer next week to try to have them complete the repair one final time. If approved, I will only need to pay for the bypass conversion. So fingers crossed. I feel as if my insurance company would rather me die of esophagus cancer than keep me from dying from cancer. It is truly sad.

That is a frustrating situation I'm certain. I haven't gotten that far yet as my EGD is next week. My doctor seems to think he can get a hernia repair approved, so if that were the case I'd only be on the hook for the extra work related to the RNY if I decided to do it.

[wdbass 5]

I had revision surgery 10 days ago to resolve my problems with GERD. My surgeon said that, without converting from the sleeve to by-pass, my hiatal hernia would return within 6 months.

Despite the adjustments required for the by-pass, it’s been wonderful waking up each day without feeling that I have a bonfire burning inside me!

[shriner37 249]

To follow up on this topic, I had my EGD today and the surgeon said he saw about a 3cm hiatal hernia. He went ahead and scheduled me for hernia repair and revision to RNY next week.

I'm looking forward to resolving the hernia issues and also the GERD.

[I♡BypassedMyPhatAss♡ 804]

4 minutes ago, shriner37 said:

To follow up on this topic, I had my EGD today and the surgeon said he saw about a 3cm hiatal hernia. He went ahead and scheduled me for hernia repair and revision to RNY next week.

I'm looking forward to resolving the hernia issues and also the GERD.

Congrats!

[wdbass 5]

I had sleeve to by-pass surgery two weeks ago today, as well as repairing a hiatal hernia. My doctor told me that, without the by-pass, the hernia would reappear, possibly within 6 months.

It’s been wonderful to wake up each day without all of the problems related to the hernia. The weight loss is a happy side benefit!

[mae7365 372]

I have Aetna, and my revision due to GERD and esophagitis was covered and I was not required to meet any of the pre-surgical bariatric parameters like diet, psych eval etc. I also had hernia repair, but the primary reason for the revision was the GERD and esophagus damage. I did have to have all the medical tests that proved I had GERD and esophagitis. The RNY revision was medically necessary and insurance approved and covered the surgery.

I have lost 60 pounds since the revision surgery which has been a very pleasant side effect of the revision. Being able to sleep without acid in my mouth has been wonderful!

[southernbanded 4]

1 hour ago, mae7365 said:

I have Aetna, and my revision due to GERD and esophagitis was covered and I was not required to meet any of the pre-surgical bariatric parameters like diet, psych eval etc. I also had hernia repair, but the primary reason for the revision was the GERD and esophagus damage. I did have to have all the medical tests that proved I had GERD and esophagitis. The RNY revision was medically necessary and insurance approved and covered the surgery.

I have lost 60 pounds since the revision surgery which has been a very pleasant side effect of the revision. Being able to sleep without acid in my mouth has been wonderful!

I am happy to hear you are seeing much success since your revision. I received notice that my biopsies came back showing Barretts Esophagus. Insurance is still denying saying that it was caused by acid reflux which was a complication caused by having VSG. As if I wanted to have Barretts Esophagus when I had VSG... ridiculous.

[louwho53 0]

I had sleeve to by-pass surgery two weeks ago today, as well as repairing a hiatal hernia. My doctor told me that, without the by-pass, the hernia would reappear, possibly within 6 months.

It’s been wonderful to wake up each day without all of the problems related to the hernia. The weight loss is a happy side benefit!

I got my surgery date today for the same surgery! I can't wait to have some relief!

Sent from my SM-G981V using BariatricPal mobile app

[lolarose13 147]

On 02/14/2022 at 12:59, mae7365 said:

I have Aetna, and my revision due to GERD and esophagitis was covered and I was not required to meet any of the pre-surgical bariatric parameters like diet, psych eval etc. I also had hernia repair, but the primary reason for the revision was the GERD and esophagus damage. I did have to have all the medical tests that proved I had GERD and esophagitis. The RNY revision was medically necessary and insurance approved and covered the surgery.

I have lost 60 pounds since the revision surgery which has been a very pleasant side effect of the revision. Being able to sleep without acid in my mouth has been wonderful!

I’m so glad this is working for you. I also have Aetna. I have GERD, but the EGD only showed a hietal hernia. I looked at the guidelines and they changed the requirements if get a revision to bypass only for GERD. I’m hoping the hernia repair will be enough to get approval. anyone knows more about this?