VSG to RNY - will I be just trading one set of problems for another?

[lauraellen80 855]

Hello - I had gastric sleeve in June of 2015 and lost over half my body weight initially, getting down to well below my initial goal in the first year. Started having issues with acid reflux pretty early on, and it's gotten steadily worse, especially in the past 3 years. I'm currently on omeprazole and famotidine, plus Tums in addition. A 24-hour PH study showed that I had over 100 episodes of reflux in that period. So I was approved to revise to a gastric bypass.

I also have regained over half of what I lost, mostly since my reflux has gotten worse, and am about 50 pounds heavier than my ideal weight. The reflux makes me feel hungry all the time, and I'm eating way more carbs than I should because they seem to tame the acid somewhat. I understand that it's pretty much a pipe dream that I'll be able to lose anything close to that with revision, but I guess any weight loss would be better than where I am right now. My new surgeon said she expected that I'd get back down to 110-120 after revision (my preferred weight personally is around 125), but based on all the posts I've read here and on reddit, she is definitely exaggerating to make me more willing to go through with the surgery. The best it sounds like I could hope for is to lose maybe 15-20 pounds over the course of a year or more?

I am scheduled for surgery on Jan. 18th, but I'm having second thoughts after reading so many horror stories of unpredictable dumping episodes and ever-changing food intolerances. I guess maybe my reflux isn't as bad as others, since the reality of daily life with RNY seems unbearably miserable to me in comparison to my life currently.

I'm afraid that I won't be able to do my job anymore (or even leave the house at all) if I am unable to eat or drink anything without the risk of vomiting/foamies (I have pelvic floor issues, so I pretty much always lose bladder control when I vomit or dry heave) or having uncontrollable diarrhea. After revision, do you have to wear an adult diaper all the time? Has anyone developed an eating disorder based on fear of getting sick after consuming anything? Do you have any "safe" foods, or is it always a (literal) crapshoot?

I know that continued GERD can cause esophageal cancer down the line, but wouldn't the same be true of daily vomiting? Has anyone who is several years out from revision developed cancer or precancerous damage to their esophagus due to the constant vomiting? Likewise, have your teeth been ruined from it?

For those who revised from VSG to RNY and are past the initial healing stages, would you do it again or has it made your life even worse?

[catwoman7 11,212]

only about 30% of bypass patients dump, and it can be prevented by not eating a ton of sugar or fat at one sitting. I've never dumped and I know lots of other bypass patients who've never dumped, either.

I had some food intolerances the first few months but now the only thing my stomach doesn't seem to handle well is a really fatty meal. Something like a fish fry with fried fish, tartar sauce, French fries, a roll with butter, and coleslaw (as is a popular Friday night meal here in Wisconsin) would not sit well with me and might even send me into the bathroom. I could handle one or two of those things, but not all (like I could pre-surgery). I also can't eat tons of Pasta or rice since it sits in my stomach like a brick, but I can eat SOME of it.

I had some vomiting episodes the first couple of months after surgery if I ate too much or too fast or something that didn't agree with me, but since then, I don't think I vomit much more often than I did pre-surgery.

Diarrhea isn't that common with bypass - and the adult diaper thing would be really rare - I almost never hear of that, and I've been on this site for about nine years. The opposite, Constipation, is really common, though. A lot of us have to take daily Miralax or stool softeners to keep on top of it.

yes I suppose constant vomiting could rot your teeth, but I'm not sure where you got that idea that bypass patients experience daily vomiting. I probably vomit 2 or 3 times a year. Plus vomiting now is much easier than it was pre-surgery. Your stomach is really small, so not much comes up. And besides that, you don't have nearly as much acid in your stomach (you can tell because what comes up tastes just like it did going down - you don't get that awful "vomit-y" taste any more after you vomit). Also, GERD is what can lead to Barrett's esphagus an/or esophagus cancer, and bypass usually improves if not outright cures GERD. That's why it's usually recommended over VSG for patients who have GERD.

I should add that I'm not a revision patient, but I know of a lot of people who are from this site and similar sites. Most of them are very happy with their bypasses and aren't experiencing the complications that you're worried about (in fact, most don't have any complications at all).

I hope you don't take this wrong, but you might want to do more research on the bypass because I think your views on it aren't that realistic. I wouldn't go so far as to say that no one has every experienced any of that stuff because I don't know for sure - maybe someone or a few people have - but we just don't hear about those things on here. If they happen, they're very rare, otherwise we'd hear about them given all the thousands of people who've been on this site over the years.

[swimbikerun 1,045]

I'm a sleeve to bypass conversion. I had a hernia, that complicated matters. I'm over a decade out from the horror of that sleeve. I'm just over 3 months out with the bypass.

The hernia caused issues and the longer healing time was due to it. If I have any pull or ache, its in that area.

For 3 months gone, the reflux (was like yours, actually worse, I had carafate to eat anything) is gone. I've had 1 time where some stuff came up like reflux. A mild little one for the 2nd time it happened. That's it. I control how much food goes in. When I dont, I throw up. I've had a bean get stuck (wow was that painful), couple of times I've swallowed 3x instead of 2 for liquids and it was too much. I've thrown up but nothing like before. If I'm really really careful, watch the time and amount of food at one time frame, I'm good. Stay at 2 swallows, I'm good. After the misery of before, this is great!

That having been said, I dropped to malnutrition level because of some other medical problems. As of end of last week, I am 8 pounds from being overweight for my BMI. 36 pounds from being normal weight. So I don't think I'll be dropping it like I did my sleeve. I dropped 27 pounds the first month, and that was 27% of the excess body weight.

[The Greater Fool 2,023]

All things are possible. Not all things are probable. Horror stories are least likely of all. Prepare for the worst, hope for the best, and focus to doing your best either way. I've only had Bypass so I can't address going from Sleeve to Bypass. But I am responding because I do have some of the issues you fear...

I dump on both sugars and fats, and it doesn't take exceptionally large quantities to kick in. I actually wanted to dump so that sugars and fats wouldn't be things I could eat with impunity. I hoped dumping would put my body to work for me on this and I have to admit I'm very happy with the result. It took an amazingly few dumping episodes for me to change my habits.

Throwing up is an entirely different beast than pre-op. The only time I throw up is when food get's stuck going down. Again, it took an amazingly few episodes of doing it wrong to learn to take my time and do it correctly. I can't recall the last time this was an actual issue. Once the food goes down, it's pretty much impossible for me to throw up. If my body insists on it, I just end up with dry heaving, which is less fun than it sounds.

On balance things could be worse.

Try not to borrow troubles from tomorrow.

Good luck,

Tek

[SleeveToBypass2023 2,598]

I'm a sleeve to bypass revision, and it's honestly the best thing I've ever done. The only time I have dumping is if I eat too many carbs. I only did that twice (holidays both times) and I learned REALLY quick not to anymore. I stick to my diet religiously and have had no issues. If you look at my signature, you'll see I've lost weight with the revision, although nowhere near what I lost with the sleeve initially. I do think your doctor is exaggerating what you'll lose. If you exercise, stick to your diet (or get back on track with it), and get your relationship with food back to where it should be, you'll do fine. My recovery with the bypass was amazing. I've had absolutely no issues with the revision at all. My only regret is that I didn't just do the bypass to begin with. Oh, and I did the revision because of major complications from the sleeve (GERD - never had it before the sleeve - gastritis, esophagitis, polyps all through my stomach and duodenum due to excessively high PPI over a long period of time, etc..).

[GreenTealael 25,335]

On 12/26/2023 at 2:36 PM, lauraellen80 said:

since the reality of daily life with RNY seems unbearably miserable to me in comparison to my life currently.

I initially had VSG in 2017 and was revised to RNY in 2019. I have no horror stories. Some mild but utterly manageable complications early on but nothing that has made me regret life post RNY compared to VSG.

Honestly to me it feels exactly the same and I have lived with the change long enough to make the comparison. In the early stages post revision, I needed to relearn and change some things but after that it’s been smooth. I deal with dumping syndrome (but I did with VSG also) so I know what to stay away from and it has eliminated 95% of the possibility of it happening.

As always, your experience may differ in any number of ways but IMHO the people who struggle the most with revisions are the ones who either have very serious physical complications or those who didn’t want to be revised at all (this is more mental than physical).

I hope you choose the best path forward that you are comfortable with. Keep us updated ❤️

[BHoenig 31]

I just had a revision from the sleeve to a bypass a week ago today. I'm already 16 pounds down. I had horrible stomach acid... the thing is, lifelong taking medicines for stomach acid is bad for you. Increases cancer risks, dementia risks, and accelerates bone loss. I did not want to be taking these meds for decades to come when science has proven how dangerous that is.

I've had no vomiting or nausea while healing. This time around, the Vitamins don't even make me sick which is a huge relief. They used to.

[rosebud68 1]

I had revision May2023 due to stage 2 esophagitis the herd was extremely bad. Since May I’m down 74 lbs it’s definitely much different from the sleeve . I HAVE NO HEARTBURN!. I went to a new dr for this and his program has helped me tremendously. I just stick to their guidelines and exercise 4-6 days a week.

[lauraellen80 855]

Thanks for all the replies, everyone. On the advice of my therapist and my surgeon's nurse practitioner, I stepped away from bariatric social media for a bit before my revision.

The surgery went OK - it did take 6 hours, as my surgeon found a considerable amount of irregular tissue on my sleeved stomach that had to be removed and biopsied. Thankfully it turned out to be benign - probably was scar tissue from my sleeve surgery.

I did have more pain and nausea immediately after surgery this time than the first time around and ended up staying a second night in the hospital until that was under control. It got much easier from there, and I only took 2 of the oxycodone they sent home with me (right before bedtime on the first two nights at home), and then minimal Tylenol for the next few days.

I've been able to get all my fluids and Protein in from the start. Pain is now minimal, my incisions are healing well. I'm starting to get my energy back albeit slowly. I'm now on soft foods and have tolerated each new food I've introduced without any problems, My biggest issue is Constipation - I don't remember it being this bad after my sleeve. I'm using Colace, Benefiber, and Miralax. I wish I could drink coffee, that would help! 😫

My surgeon also left my pouch a little on the larger side, saying she doesn't want me to lose TOO much weight. I'm pretty disappointed about that, since I had 40-50 pounds to lose. I'm definitely already on the upper end of the amount I'm supposed to be eating at this point - 4oz. per meal (3oz. protein + 1oz. fruit/veg). I am down about 10lbs since surgery at 3 weeks post-op and just got back out of the OBSESE category. Hopefully I'll continue to lose at least something over the next few months.