Revision Surgery Recommended for Hiatal Hernia?

[Kim 713 0]

I had my sleeve done in 2014. I had an endoscopy done last week. Doctor says I have a hiatal hernia, esophagitis and gastritis and recommends the Roux-en-Y procedure to repair and revise. I’m scared for that procedure for some reason.

Is it common for the doctor to recommend revision & repair over just repairing the hernia? He said that it could come back larger so that’s why they don’t recommend just the hernia repair. Anyone heard this? I’m trying to make the best decision. Thank you! :)

[swimbikerun 1,046]

I just had a repair and revise. He's correct - I had been given the same thing. You already have a sleeve that is going back and forth, the chances are greater, if you leave it and just do the hernia repair, that it will return. There's already diaphragm weakness.

[RickM 1,747]

There is a good reason to avoid the RNY revision if you can - the reactive hypoglycemia and marginal ulcer (and all of the medical care limitations that stem from it) issues, but it's not the end of the world, either if that's what you need. It's a common procedure that's been done in one form or another for 140 years, so its quirks and features are well known (but I would rather avoid its quirks if I can).

I would certainly get a second, and even third, opinion on it, as while the sleeve is a fairly straightforward procedure most to do these days, repairing one that isn't working correctly is not necessarily so. Most bariatric surgeons started out with the bypass, so that is their comfort zone and they often prefer to go back to the familiar when things get a bit complicated, while there are some who have gone deeper into the sleeve and specialized in it and related procedures, such as the DS, and they are more comfortable doing things that others wouldn't do. We sometimes hear on these forums that "you can't do a Nissen (fundoplication) on a sleeve as there isn't any fundus left (well, not much) yet there are some who routinely perform them. Between that and meshing, there are options, and an RNY doesn't necessarily fix the potential recurring problem, as it, too, yield a small stomach pouch that is subject to herniating.

If possible, for a second opinion, I would seek out a surgeon who does the DS (duodenal switch) as that is a good proxy for one who is well experienced with dealing with sleeves, and is more comfortable with more complex procedures as well. If they recommend an RNY revision, too, then that's a pretty solid confirmation of what's appropriate for your specific case.

[swimbikerun 1,046]

I am 1 day less than 2 weeks out of a para esophageal sliding hernia repair and Sleeve to RNY revision. My reflux, BAM is gone. I'm not vomiting or feeling like yuck. My surgeon could do a DS and has. I'm not having problems and while it doesn't mean I will or won't later, at least I'm free of the medical issues and the like I had before. I'm also down about 35 pounds in the little over 2 months since I got sick.

Really happy as the medical issues were outweighing the weight, especially at the end.

[RickM 1,747]

That's great! But there are surgeons out there whose main solution to any problem is to do an RNY; this is why we need to be careful and get second opinions, particularly on revisions where there are often multiple solutions to consider. Sometimes there isn't much of a choice and the path is clear, other times things aren't so clear and there may not be one "right" call, or only a choice of lesser evils. Surgeons often have a preference based on their experiences, so you can get different choices for the same problem, or they may agree despite preferences. That's why we seek out second opinions as we aren't qualified to make the call, or to fully evaluate a surgeon's proposed solution.

[Cyncha21 6]

I posted this on another thread about revision, but I had a hiatal hernia and bad GERD so it applies for this thread too.

I want to preface that this is about to be a long message, but it's my journey. Thanks for reading.

My 1st Bariatric journey started in 2009 (I was 26 years old). My heaviest weight was 250 lbs. I did a month liquid diet as my preop diet and got down to my surgery weight of 220 lbs. I had a sleeve done in Sep 1, 2009. I got down to around 175 lbs from my surgery weight of 220 lbs. I got down to a size 12. I did regain some weight years later, but that was my doing (not eating the best, not exercising as I should). In addition to gaining some weight back, i developed a 5/6cm hiatal hernia and had really bad heartburn and reflux. I started taking Nexium for years. Finally 14 years later (now 40 years old) in April of 2023 I decided to ask a doctor about taking daily Nexium (after hearing constantly from family that it wasn't good). My surgeon gave me 3 options.

1. Continue taking Nexium daily
2. Fix my hiatal hernia (but he did warn me that hiatal hernias are known to come back)
3. Fix my hiatal hernia and do a revision from Sleeve to RNY.

Before any of that to make an informed decision I had to get an upper GI with contrast and an endoscopy with a Bravo study. I had the endoscopy done and the Bravo capsule placed on my esophagus. After the 1st endoscopy my GI doctor said she didn't even need to see the results of the Bravo study...seeing my esophagus alone was enough to see how inflamed my esophagus was and she confirmed the bigger sized hernia. Either way, the Bravo capsule was placed in and I did the 3 day study. The results came back and like my GI doc said...it was bad. The acidity in my stomach and esophagus was ridiculous. I use to take generic Nexium 20mg but my GI doc said that wasnt enough for how bad my esophagus was. I was told to bump it up to 40mg 2x a day. So I did that and it helped to heal the massive amount of inflammation I already had in my esophagus. To confirm that I had a 2nd endoscopy done. The Bravo study, the upper GI scans, the endoscopy was all completed so that I could make an informed decision on how I wanted to proceed. Which of the 3 options discussed did I want to proceed with. I decided option 3 was best (revision from Sleeve to RNY with a hiatal hernia repair). For me my insurance approved the procedure and it was fairly a quick process because I went the general surgical route vs the Bariatric route. I could have had the revision in July but I had a cruise planned in August and I wanted to be able to drink and eat and ENJOY my vacation so I opted to wait and had the revision 2 weeks after I came back from my cruise on September 11th.

I was 215 the 1st day of my preop diet. I got down to 206 but then mother nature decided to show up the week of my surgery so as women we gain Water weight during our cycle and the day of surgery i weighed in at 209. I was so pissed. I knew it was water weight because of my cycle but still nobody wants to see the number on the scale go up. Surgery went well. I had no complications. My recovery was A LOT smoother. I had BAAAAAD nausea and gas pains after my sleeve becauseof the anesthesia. With the RNY I had 0% nausea. I had a little bit of shoulder pain because of the gas and I did have another pain when I inhaled big because of the hernia repair, but it was all normal and pains of that nature were expected. I was just sooooo glad that I didn't wake up extremely nauseous after the RNY like I did after my sleeve. So now I'm 31 days post op. I've been at 195 since like September 26th. I hope that I've HOPEFULLY lost at least 1 pound now since I've been stalled at the same weight for 2 weeks. Btw I'm 5'4 for reference. My size 14 clothes button again and my 16s are getting a little loose on me now. I'm not swimming in my clothes or nothing but it's a small progress. I was wearing XL shirts and now Large shirts fit me a lot better. I feel less like a sausage in them lol! Oh and tonight I tried on this bra that I know for a fact a couple of weeks ago could not button or even come close and today it fit. So now a 38D will fit. Great non scale victory! I can tolerate all food and as long as I don't take huge bites and I chew my food well and eat slow, I'm good. Otherwise I've already had my 1st reminder of what it feels like to throw up because your food feels stuck. I had that happen after the sleeve sometimes too and it sucks, but it's a process learning how to eat again and reminding myself that I can't inhale my food. I am taking a daily Vitamin with Iron and then 3 calcium citrate chewable daily. My doctor also still wants me to take 1 Omeprozole daily for 6 months post op to give my esophagus and hernia repair time to truly heal. 1 month down....5 months to go. Then I'll be able to see if I don't have any GERD or heartburn without any medication. The weight loss is a perk and I definitely want to lose more weight and get down to 150 or at least my best sleeve weight of 175, but I always have to remind myself that my goal of this entire revision surgery was to not deal with heartburn and reflux anymore.

So yeah...thats my revision story so far. Please let me know if you have any questions. I'll be happy to answer.