VSG to ESG Surgery??-Why??

[teedsg 253]

Does this make sense? I live in Atlanta, GA and I've had two consultations for sleeve revisions. Both doctors are pushing for an ESG. To me it doesn't make sense. Sure it's less invasive and through the endoscopy route, but, I'm a little apprehensive. Neither of them said it will help GERD nor did they mention a good weight loss. An average of 15-20% weight loss is not good stats to me because it'll only give me approximately 40 lb weight loss. It seems like a quick fix that won't last long. Can anyone suggest any good Atlanta surgeons for a sleeve to bypass surgery? My google search is coming up short. There's one surgeon in Johns Creek I would like to try but it's out of reach monetarily because I'm self-pay. I'm 223, 5'4 and 5 years out of VSG. I want a revision because of GERD and weight re-gain. Any insight is helpful.

[liveaboard15 1,293]

never heard of a revision from sleeve to ESG... which ESG is basically the sleeve. They sew thru your mouth into your stomach... Every revision i have seen on here is from sleeve to bypass or some form of bypass like mini bypass or that Duodenial switch or however you spell it.

[teedsg 253]

1 hour ago, liveaboard15 said:

never heard of a revision from sleeve to ESG... which ESG is basically the sleeve. They sew thru your mouth into your stomach... Every revision i have seen on here is from sleeve to bypass or some form of bypass like mini bypass or that Duodenial switch or however you spell it.

Exactly. Their suggestions has just really thrown me off. smh...

[RickM 1,747]

Likewise, I don't see the sense of it The ESG by its nature is more limited in what it can do by virtue of its limited surgical procedure - they just can't do as much endoscopically as they can do by going in laproscopically. And, from what I have seen the ESG doesn't have as good results as the basic VSG, either.

A few other random considerations:

Revisions of any kind tend to have less performance than a virgin procedure - my simple minded picture is that you have already had your stomach reduced from 32-64 oz capacity down to 2-4 oz and you have learned to eat around that; even if it has stretched out some, cutting it back to 1-2 oz isn't going to do much.

The RNY isn't markedly different than the VSG in weight loss or regain performance, so don't expect a lot from that, maybe 20 lb would be typical, mostly from a return to the extreme dieting one has to go through around surgery time.

If you have had significant regain, first step is to evaluate the cause and treat that; as noted above, the RNY isn't markedly better than the sleeve, so unless you correct what went wrong in the first place, you will be back here again in a couple of years, but with fewer options (the RNY is a trickier thing to revise once you get it, so consider it to be a one way street.)

Are you insured, but not covered for WLS, or not insured at all? if you have a significant GERD problem, then correcting it may/should not be considered WLS. but correcting a threatening health condition, possibly the result of an earlier surgery. Check it out before giving up on that avenue.

How severe is your GERD? have you had it evaluated? If it is beyond treatment with meds and lifestyle changes, then surgery may be called for. It might be an RNY type procedure (don't refer to it as an RNY to your insurance as that will guarantee a negative answer if they don't cover WLS; there are a number of procedures that derive from the same procedure that gave rise to the RNY, and they are used for treating multiple problems; but they may go under a different name, so let your chosen surgeon work that out with the insurance company.

Again, have your issue evaluated - if surgery is needed, a resleeve may do the job without going to the RNY, or it may not as it depends on what's going on with your sleeve.

[teedsg 253]

57 minutes ago, RickM said:

Likewise, I don't see the sense of it The ESG by its nature is more limited in what it can do by virtue of its limited surgical procedure - they just can't do as much endoscopically as they can do by going in laproscopically. And, from what I have seen the ESG doesn't have as good results as the basic VSG, either.

A few other random considerations:

Revisions of any kind tend to have less performance than a virgin procedure - my simple minded picture is that you have already had your stomach reduced from 32-64 oz capacity down to 2-4 oz and you have learned to eat around that; even if it has stretched out some, cutting it back to 1-2 oz isn't going to do much.

The RNY isn't markedly different than the VSG in weight loss or regain performance, so don't expect a lot from that, maybe 20 lb would be typical, mostly from a return to the extreme dieting one has to go through around surgery time.

If you have had significant regain, first step is to evaluate the cause and treat that; as noted above, the RNY isn't markedly better than the sleeve, so unless you correct what went wrong in the first place, you will be back here again in a couple of years, but with fewer options (the RNY is a trickier thing to revise once you get it, so consider it to be a one way street.)

Are you insured, but not covered for WLS, or not insured at all? if you have a significant GERD problem, then correcting it may/should not be considered WLS. but correcting a threatening health condition, possibly the result of an earlier surgery. Check it out before giving up on that avenue.

How severe is your GERD? have you had it evaluated? If it is beyond treatment with meds and lifestyle changes, then surgery may be called for. It might be an RNY type procedure (don't refer to it as an RNY to your insurance as that will guarantee a negative answer if they don't cover WLS; there are a number of procedures that derive from the same procedure that gave rise to the RNY, and they are used for treating multiple problems; but they may go under a different name, so let your chosen surgeon work that out with the insurance company.

Again, have your issue evaluated - if surgery is needed, a resleeve may do the job without going to the RNY, or it may not as it depends on what's going on with your sleeve.

Thank you for your response. I haven't gotten my GERD checked out for a couple of years, but I know it's getting worse. Part of the regain issue is due to binge eating disorder. I'm still getting treated for that and learning to do other things besides eating. It's been helping, but not really a lot of weight loss (3 lbs since last month), but I can't really get below 220 at all anymore. I'm on HBP meds since last Friday and managing to get it down. I'm totally self-pay for now and the surgeon can correct the gerd, but it won't cover anything dealing with bariatrics under my insurance plan. I guess his office doesn't know how to get it to clear the insurance. I have insurance it just won't cover me for surgery.

[Sleeve_Me_Alone 656]

1 hour ago, teedsg said:

Thank you for your response. I haven't gotten my GERD checked out for a couple of years, but I know it's getting worse. Part of the regain issue is due to binge eating disorder. I'm still getting treated for that and learning to do other things besides eating. It's been helping, but not really a lot of weight loss (3 lbs since last month), but I can't really get below 220 at all anymore. I'm on HBP meds since last Friday and managing to get it down. I'm totally self-pay for now and the surgeon can correct the gerd, but it won't cover anything dealing with bariatrics under my insurance plan. I guess his office doesn't know how to get it to clear the insurance. I have insurance it just won't cover me for surgery.

Is the surgeon a bariatric surgeon? If so, maybe go see a GI specialist specifically for the GERD and go from there?

[teedsg 253]

1 hour ago, Sleeve_Me_Alone said:

Is the surgeon a bariatric surgeon? If so, maybe go see a GI specialist specifically for the GERD and go from there?

Yes, the IBI doctor is a bariatric surgeon and the TrueYou doctor said he's a gastrointerologist specialist. I guess I'll go back to the drawing board to find a few more bariatric surgeons and also find a GI specialist. I appreciate everyone's help and insight.

[SleeveToBypass2023 2,598]

Everything I've seen on here about getting a revision from sleeve because of GERD has been to the bypass. I've heard the bypass actually greatly diminishes or even eliminates GERD. And gives additional weight loss (although less than initial surgery, it still gives some). It might take another year, but you should be able to get that last 65 pounds down with the bypass, and have relief from the GERD. I would talk to your doctor again, and if he still won't budge from the ESG, find another doctor.

Edited August 11, 2022 by SleeveDiva2022

[Tomo 1,191]

So basically they want to re-sleeve you which doesn't make sense if you have gerd. A few years ago, I originally asked my surgeon who regularly does ESG if I can have that instead of the bypass (I was still worried about getting a bypass back then) and he adamantly said no, and it'll make my gerd worse if they tighten my sleeve. He said the sleeve puts pressure on the lower esophageal sphincter which causes reflux. Once he found out I had a gerd, he pushed for a revision to RNY for a couple of years and I kept trying different PPIs instead but to no avail. It got so bad, I finally had to get the revision to RNY last August.

[teedsg 253]

1 hour ago, SleeveDiva2022 said:

Everything I've seen on here about getting a revision from sleeve because of GERD has been to the bypass. I've heard the bypass actually greatly diminishes or even eliminates GERD. And gives additional weight loss (although less than initial surgery, it still gives some). It might take another year, but you should be able to get that last 65 pounds down with the bypass, and have relief from the GERD. I would talk to your doctor again, and if he still won't budge from the ESG, find another doctor.

Absolutely. He won't budge, and I am out to find another surgeon. 🙂

[teedsg 253]

16 minutes ago, Tomo said:

So basically they want to re-sleeve you which doesn't make sense if you have gerd. A few years ago, I originally asked my surgeon who regularly does ESG if I can have that instead of the bypass (I was still worried about getting a bypass back then) and he adamantly said no, and it'll make my gerd worse if they tighten my sleeve. He said the sleeve puts pressure on the lower esophageal sphincter which causes reflux. Once he found out I had a gerd, he pushed for a revision to RNY for a couple of years and I kept trying different PPIs instead but to no avail. It got so bad, I finally had to get the revision to RNY last August.

WOW! That's good to know. I'm definitely going to move on to find a RNY surgeon. The trueyou surgeon told me it'll get better (GERD), that's crazy. I can't trust it. I'm going to get the RNY. Thanks for the feedback!

[teedsg 253]

20 hours ago, SleeveDiva2022 said:

Everything I've seen on here about getting a revision from sleeve because of GERD has been to the bypass. I've heard the bypass actually greatly diminishes or even eliminates GERD. And gives additional weight loss (although less than initial surgery, it still gives some). It might take another year, but you should be able to get that last 65 pounds down with the bypass, and have relief from the GERD. I would talk to your doctor again, and if he still won't budge from the ESG, find another doctor.

I'm so happy, I am going to a different doctor. I have a consult on Monday 8/15/22 to discuss the sleeve to bypass and the DS.

[RickM 1,747]

If the GERD is the result of a hiatal hernia, not an uncommon thing and a common cause of GERD, with or without WLS, then that can be corrected, though some surgeons may not be great at doing that with a sleeve - some can, some can't and will route you direct to a bypass instead. A resleeve might be appropriate if the original sleeve was malformed - that used to be more common 8-10 years ago when most bariatric surgeons were still learning how to do the sleeve (as one prominent surgeon put it, "twenty years of doing bypasses and they think they know how to do a sleeve....") but that is less common more lately, but something still to check out.

If you are consulting someone who does the DS (particularly the "traditional" BPD/DS,) that's a good thing as they typically are the most skilled at working with sleeves, and can give a good reading as to what condition yours is in. If one of them tells you that the bypass is the way to go (even though they may normally prefer the DS,) then that's usually sound advice.

[teedsg 253]

On 8/12/2022 at 8:19 PM, RickM said:

If the GERD is the result of a hiatal hernia, not an uncommon thing and a common cause of GERD, with or without WLS, then that can be corrected, though some surgeons may not be great at doing that with a sleeve - some can, some can't and will route you direct to a bypass instead. A resleeve might be appropriate if the original sleeve was malformed - that used to be more common 8-10 years ago when most bariatric surgeons were still learning how to do the sleeve (as one prominent surgeon put it, "twenty years of doing bypasses and they think they know how to do a sleeve....") but that is less common more lately, but something still to check out.

If you are consulting someone who does the DS (particularly the "traditional" BPD/DS,) that's a good thing as they typically are the most skilled at working with sleeves, and can give a good reading as to what condition yours is in. If one of them tells you that the bypass is the way to go (even though they may normally prefer the DS,) then that's usually sound advice.

Yes, the office I'm going to get the consult at has lot's of experience with DS's. You made some good points. One thing is for sure, they will definitely need to do further testing to see what condition my sleeve is in. I'm just excited about moving forward and finding a good surgeon who will listen, wants to know more about my journey, and where I want to go with this. I need a second chance to get this right because I didn't get to my goal, reflux, and I should have gotten the bypass to begin with. I know I need to fight to make lifestyle changes, but the push of the surgery and having a better relationship with food is going to get me there.

[RickM 1,747]

Second guessing and some regret is normal when one runs into problems. It is well to realize that whatever road you chose in the past was likely to be bumpy, even if the bumps might have been different. The bypass, in addition to having its own quirks (someone just showed up on today's recent topics column who is having reactive hypoglycemia problems - that's one of those quirks,) that can cause regrets, would not likely have been any better on helping you with your regain (RNY and VSG are very similar in that regard,) and is also more difficult to revise should you have had problems. So, there is (and was) no easy, straight answer. We follow what looks like the best road for us and take what life throws at us over time..