Revision

[Rashi 25]

As I am just a few days away from surgery I've come across many stories of revision procedures. For those who have had to do this or know someone who has... I'm curious what some of the reasons were ?

[catwoman7 11,212]

the majority are due to people who had sleeve who developed gastric reflux (GERD) that couldn't be controlled medically. They usually revise to bypass since bypass tends to improve (or in many cases, cure) GERD.

a few are due to people who revise from sleeve to either bypass or SADI or DS because they didn't lose the amount of weight they'd hoped to

I've seen a handful of cases in the nine or ten years I've been on here of people revising from bypass to DS (again because they didn't lose the amount of weight they'd hoped to), but that's a complicated revision that's not done very often

and then there are a few cases that don't fit it any of these categories, such as Sleeve2bypass's case (she's still here on Batriatric Pal), but those are really rare

Edited August 30 by catwoman7

[ShoppGirl 4,785]

Mine was because of regain post sleeve. My surgeon said that the sleeve is a really great procedure and it works great for so many people but obesity is complex and some people just need a little more of a metabolic change to be successful. I have the added complexity of bipolar disorder and anxiety. The depressive episodes and the anxiety cause me to make less healthy choices and some of the meds that go with it that cause weight gain as well. I went with the sleeve because of the meds and it causing less absorption issues and it was certainly wise to try it first but it just wasn’t the right choice for me.

I just revised to SADI three weeks ago and according to my NP I am doing great in terms of loss for a revision and my recovery. I certainly feel great and I am not craving sweets which was another reason I think I regained. It’s not at all common according to my surgeon (usually it’s the opposite and sweet cravers stop craving them) but post sleeve I went from a savory person to one that craved sweets. During the liquids stage post sleeve my cravings were for various deserts. Post SADI I am craving Fish Tacos and apples with Nut Butter so I think that may have reversed itself which will make things sooooo much easier.

Edited August 30 by ShoppGirl

[SleeveToBypass2023 2,598]

Mine was due to complications from the sleeve. I had gastritis, esophagitis, and horrendous gerd. I was taking such high amounts of PPI (80mg of Nexium per day plus Pepcid and TUMS for break through gerd) that I developed so many polyps throughout my stomach it took 4 endoscopies to remove them all. Had my revision from sleeve to bypass and have been great ever since.

[tinyforks 14]

On 9/1/2024 at 11:29 AM, SleeveToBypass2023 said:

Mine was due to complications from the sleeve. I had gastritis, esophagitis, and horrendous gerd. I was taking such high amounts of PPI (80mg of Nexium per day plus Pepcid and TUMS for break through gerd) that I developed so many polyps throughout my stomach it took 4 endoscopies to remove them all. Had my revision from sleeve to bypass and have been great ever since.

Can you tell me more about your symptoms? What did the gastritis and esophagitis feel like? How long did it take you to develop polyps and how did you know? Thank you so much in advance!

[SleeveToBypass2023 2,598]

9 hours ago, tinyforks said:

Can you tell me more about your symptoms? What did the gastritis and esophagitis feel like? How long did it take you to develop polyps and how did you know? Thank you so much in advance!

I started having issues around 8 months post op from the sleeve. It started off as heartburn and quickly turned into GERD. I was having horrible, sharp stabbing pain in my stomach, burning in my stomach going up my esophagus and into the back of my throat, and I had a lot of nausea. I wasn't able to eat much because everything triggered the GERD, even milk and Water and bread. My surgeon put me on 40mg of Nexium in the morning and it didn't touch it. So he upped it to 40mg twice per day, and it helped but I still had break through GERD so he also had me take Pepcid once per day and TUMS as needed. That kept things mostly at bay, but that was such a high amount of PPI over a long period of time that I started to develop polyps. He sent me to have a barium swallow and they found the gastritis and esophagitis and GERD that way. So then he sent me to have an endoscopy and they found my stomach was literally COVERED in polyps. It took 4 endoscopies in total to remove them all. After that I was told I had to have the revision to bypass, so I did. That was the best decision I ever made.

[tinyforks 14]

6 hours ago, SleeveToBypass2023 said:

I started having issues around 8 months post op from the sleeve. It started off as heartburn and quickly turned into GERD. I was having horrible, sharp stabbing pain in my stomach, burning in my stomach going up my esophagus and into the back of my throat, and I had a lot of nausea. I wasn't able to eat much because everything triggered the GERD, even milk and Water and bread. My surgeon put me on 40mg of Nexium in the morning and it didn't touch it. So he upped it to 40mg twice per day, and it helped but I still had break through GERD so he also had me take Pepcid once per day and TUMS as needed. That kept things mostly at bay, but that was such a high amount of PPI over a long period of time that I started to develop polyps. He sent me to have a barium swallow and they found the gastritis and esophagitis and GERD that way. So then he sent me to have an endoscopy and they found my stomach was literally COVERED in polyps. It took 4 endoscopies in total to remove them all. After that I was told I had to have the revision to bypass, so I did. That was the best decision I ever made.

Thank you for sharing your experience. I'm sorry you had to go through that.

[SleeveToBypass2023 2,598]

5 hours ago, tinyforks said:

Thank you for sharing your experience. I'm sorry you had to go through that.

I'm curious why you wanted to know the details. Are you having issues with your sleeve?

[tinyforks 14]

On 9/6/2024 at 4:58 PM, SleeveToBypass2023 said:

I'm curious why you wanted to know the details. Are you having issues with your sleeve?

I'm 9 months PO and I am having some reflux issues. I am trying to figure out how serious they are and what my next steps should be. The pain doesn't sound as intense as what you've been through, but I can really only keep it from happening with taking a PPI. My PCP advised me against taking PPIs this long, but I have been unsuccessful in weaning myself off of them. I really don't want to have a revision if I can help it, but I also know I can't be on PPIs forever.

Edited September 14 by tinyforks
misspelling

[ShoppGirl 4,785]

16 minutes ago, tinyforks said:

I'm 9 months PO and I am having some reflux issues. I am trying to figure out how serious they are and what my next steps should be. The pain doesn't sound as intense as what you've been through, but I can really only keep it from happening with taking a PPI. My PCP advised me against taking PPIs this long, but I have been unsuccessful in weaning myself off of them. I really don't want to have a revision if I can help it, but I also know I can't be on PPIs forever.

Is it a low dose PPI? If so it may be okay to stay on long term. I would ask your surgeon. I have been on a 20mg Omeprazole since after my sleeve and when I had a revision for weight gain I went witb the SADI knowing that I most likely will need to stay on the Omeprazole for life. My surgeon said it would be fine for me. I’m sure if he thought that there was any concern that he would’ve steered me towards the bypass. He left it up to me. He keeps his patients on them for a time post surgery anyways so I haven’t tried without it yet.

They also may want you to try Famotodine if you are concerned about the PPI’s (it’s Pepcid). I tried the prescription version which was 20mg before my revision but it didn’t work. I just switched back to the Omeprazole without even asking if there was a stronger one since I knew I was gonna have to switch soon for my surgery anyways Maybe it will work for you??

Edited September 14 by ShoppGirl

[Arabesque 7,240]

I was wondering the same as @ShoppGirl. I’ve been taking 20mg ppi since my surgery 5 + years ago. It covers me for most of the day. Sometimes late at night I have a little reflux so I just chew some quick eze. I actually took the 20mg randomly before surgery because I already had reflux but managed it predominately with dietary choices (avoided caffeine, spicy food, rich creamy sauces & a lot of carbonation). Only needed the ppi a handful of times a year - usually if I had one too many Champagnes or gin & tonics - LOL!

Certainly worth a conversation with your doctors. And of course what may work for some may react differently with you or you have other health issues to consider.

[SleeveToBypass2023 2,598]

12 hours ago, tinyforks said:

I'm 9 months PO and I am having some reflux issues. I am trying to figure out how serious they are and what my next steps should be. The pain doesn't sound as intense as what you've been through, but I can really only keep it from happening with taking a PPI. My PCP advised me against taking PPIs this long, but I have been unsuccessful in weaning myself off of them. I really don't want to have a revision if I can help it, but I also know I can't be on PPIs forever.

The pain didn't start off intense. How high of a dose are you on and how often do you take it? Is it daily? Once a day or more often? Have you had to increase the dose or does the dose you currently take keep it controlled? If you're well controlled on a low dose, you're probably ok to stay on it. If you're not well controlled and need to increase and this continues, then you might have to look at a revision at some point. High doses of PPI aren't meant to be taken long term, and the higher the dose for a longer amount of time, the higher the chances you will likely need a revision.

[ShoppGirl 4,785]

I believe the original poster has already had their surgery, but for anyone else who is reading this as someone else who has had a sleeve and needed a revision, if you do not have a strong medical reason for choosing one surgery over the other, and you’re choosing between the sleeve and the bypass I would’ve gone with the bypass to avoid meeting to take a PPI. my only reason for going with the sleeve and giving it a try, knowing that I may have to revise was because I’m on mental health meds, and we were concerned about the absorption. The sleeve was obviously a better option for that. However, I believe it’s like 26%, I read somewhere, of sleeves that need to be revised for Gerd or inadequate weight loss/ regain. The risks with the bypass are slightly higher, but in my opinion, not enough to have to end up revising because the revision surgery in itself is riskier than either procedure plus it’s a second surgery so twice the chances to experience the risks. If your doctor offers the SADI as a virgin surgery that complicates things a bit because the risk are lower for Gerd than the sleeve and the weight loss is higher and more durable than both research has found so far but it’s a little newer, and comes with its own set of sure and long-term risks that may not have been figured out quite yet. It does have a higher no absorption, so the risk of malnutrition is slightly higher than the sleeve and bypass but lower than the DS. Long story short, there really isn’t a perfect option, only a perfect option for you.. The biggest thing to keep in mind with all the surgeries is that any risk of complication is drastically lower than the risks of staying obese.

Edited September 14 by ShoppGirl

[tinyforks 14]

On 9/13/2024 at 6:00 PM, ShoppGirl said:

Is it a low dose PPI? If so it may be okay to stay on long term. I would ask your surgeon. I have been on a 20mg Omeprazole since after my sleeve and when I had a revision for weight gain I went witb the SADI knowing that I most likely will need to stay on the Omeprazole for life. My surgeon said it would be fine for me. I’m sure if he thought that there was any concern that he would’ve steered me towards the bypass. He left it up to me. He keeps his patients on them for a time post surgery anyways so I haven’t tried without it yet.

They also may want you to try Famotodine if you are concerned about the PPI’s (it’s Pepcid). I tried the prescription version which was 20mg before my revision but it didn’t work. I just switched back to the Omeprazole without even asking if there was a stronger one since I knew I was gonna have to switch soon for my surgery anyways Maybe it will work for you??

I am on 20 mg Omeprazole daily. I was prescribed 20 mg Famotodine, but it isn't working. I am relieved to hear your surgeon is okay with a low dose. At my 6 month, my surgeon's office wanted me to get off of Omeprazole, but my PCP wanted to keep me on as long as the reflux is happening (for fear of ulcers, cancer, etc.). I was hoping the reflux would have gone away by now, so I am just trying to prepare myself for my 1 year check up and to hear what my options are.

Thank you for sharing the info with me.

[tinyforks 14]

On 9/14/2024 at 6:46 AM, SleeveToBypass2023 said:

The pain didn't start off intense. How high of a dose are you on and how often do you take it? Is it daily? Once a day or more often? Have you had to increase the dose or does the dose you currently take keep it controlled? If you're well controlled on a low dose, you're probably ok to stay on it. If you're not well controlled and need to increase and this continues, then you might have to look at a revision at some point. High doses of PPI aren't meant to be taken long term, and the higher the dose for a longer amount of time, the higher the chances you will likely need a revision.

I currently take 20 mg of Omeprazole once daily. This is down from the original 40. It seems to be controlling things as long as I take it every day. Thank you so much for the info!