Heartburn and hernia--time for bypass?

[ajb1029 37]

Hey y'all,

Haven't posted in a while but I need some insight from the community. I was sleeved December 2020, took RX strength omeprazole for 90 days post op since that was what my surgeon did., had zero issues with heartburn incidences. However, heartburn runs in my family---in the males, I didn't have issues beyond maybe once in a frozen blue moon I MIGHT have a mild case that 2 Tums fixed before surgery.

Fast forward a couple of years-heartburn incidences starts getting worse/becoming more numerous, would get up choking on acid if I laid down to soon after eating and everything seemed to cause it. Water, Protein Shakes, sugar/no sugar, etc it's just stupid. I had a bad attack of pain and nausea a few months ago that honestly had me worried about a heart attack but ended up with a CT scan and was diagnosed with a hiatal hernia--the ER doc I saw said my surgery site/stomach looked fine though. I have regained about 35-40ishlbs from where I was but I have maintained a loss of close to 80lbs. In order to survive mostly comfortably, I am living off of a lot of days multiple famotidines sprinkled through the day. Sometimes NOT eating also causes heartburn. I'm over it 120%.

Here's my question---my current insurance covers NO bariatric surgery for ANY reason. Should I pursue JUST the hernia repair in the US or should I look into going to Mexico for a revision to the Bypass with maybe also a hernia repair if that's offered? The reason I went with the sleeve in the first place was my already mild anemia that is genetic-runs in the family on the women's side unfortunately and I didn't want to contend with possibly getting really anemic or not being able to keep up with the nutrition/vitamin requirements but I can't live with this heartburn issue for another 50-60+ years (currently 35 years old).

Thanks for anyone who wants to give me some thoughts/input!

[SpartanMaker 972]

I'd try to get your insurance company to pay for both.

Gastric bypass is sometimes performed for reasons other than weight loss. Most commonly that would be for severe GERD and/or issues with gastric emptying. This happens even in patients that are not overweight and never had a previous sleeve procedure. My point is that I'd be willing to bet those procedures are covered by your insurance company since it's being done for strictly medical reasons. (Technically so is weight loss surgery, but insurance companies are stupid.)

In your case it seems pretty obvious there's also medical need, so your insurance should pay for it. They'll probably deny it at first, so be prepared to fight them.

[learn2cook 600]

I agree with SpartanMake above. Be prepared to fight with insurance. It is a medical need and eventually causes cancer. Your bariatric doctor should be able to help after you initially get declined. Fortunately, in my case the hiatal hernia was caught before bariatric surgery, but my doctor still had to fight for me. It turned out the insurance doctor was a retired pediatric physician so was not not well informed. Best of luck to you because the fight is a long hard slog. I personally feel that taking extra Vitamins is easy compared to cancer. Do what you need to do whatever your decision.

[learn2cook 600]

I know that job and state insurance choices come up yearly. Maybe you could switch to a higher/better coverage plan temporarily to get this done? Just thinking…

[ajb1029 37]

Thank you everyone, I hadn't considered fighting for coverage. I made an appointment Tuesday to at least talk to a surgeon to discuss my symptoms, options etc. It isn't my original as while I liked him quite a bit, Baylor Scott and White will never get another dime of money from me.

My other concern is that I am already coming into this low grade anemic but having to take the acid reducers so frequently also messes with the Iron absorption so that has also been a concern in the back of my mind as well.

My insurance doesn't cover any bariatric anything regardless of the plan, I even double checked today to see if just waiting and paying more for 2026 coverage would be an option but unless I get a new job with better coverage it's going to be fighting or Mexico.

[NeonRaven8919 533]

On 3/8/2025 at 1:10 PM, SpartanMaker said:

I'd try to get your insurance company to pay for both.

Gastric bypass is sometimes performed for reasons other than weight loss. Most commonly that would be for severe GERD and/or issues with gastric emptying. This happens even in patients that are not overweight and never had a previous sleeve procedure. My point is that I'd be willing to bet those procedures are covered by your insurance company since it's being done for strictly medical reasons. (Technically so is weight loss surgery, but insurance companies are stupid.)

In your case it seems pretty obvious there's also medical need, so your insurance should pay for it. They'll probably deny it at first, so be prepared to fight them.

Yes, I echo this. My uncle had to have a bypass because he had oesophageal cancer and extreme reflux as a result. He had insurance cover it.

[RickM 1,753]

The basic procedure upon which the RNY is based has been done for some 140 years for a variety of GI maladies, so it's mostly a matter of billing codes, and some minor variations in configuration, that make it a bariatric procedure vs. one for cancer, gastroparesis, etc., so insurance shouldn't be a factor if that is what is needed.

As to whether the "RNY" is needed for your case is a judgement call; try to avoid self diagnosis and let the doctors make the recommendation as to what is appropriate to treat your particular case. GERD is a classic symptom of a hiatal hernia, and given that you didn't have any particular problem with it for some years post op indicates that it is the hernia and not the sleeve that is the primary problem. Again, let the experts weigh in on this.

My preference when considering something like this would be to seek out an opinion from a bariatric practice that is associated with a regional cancer center, as they tend to treat a broader range of GI maladies than a general bariatric practice, and will probably have a wider range of options to consider. If you come across a surgeon who quickly determines that you have GERD and a sleeve, therefore you need a bypass, without looking at any imaging, I would tend to move on to someone else - they probably don't understand the sleeve as well as they should to make that determination.

My philosophy is to try to avoid going to a bypass is possible, as it does present some diagnostic and treatment limitations down the line should they be needed as we get older. The blind stomach and duodenum that can't be readily imaged or manipulated endoscopically and medication limitations (of which NSAIDs are the largest class,) are the primary things that come to mind. They usually aren't big deals if that is what is needed, but I don't like giving up options unnecessarily. RNY patients can develop GERD later on, and occasionally (though rarely,) such a revision does not correct a GERD problem, so we're talking more of a statistical improvement rather than an outright cure. If that happens, then where does one go - the bypass is something of a one way street surgically (though is can technically be reversed)? So, my inclination is to go one step at a time and treat the hernia and then go from there is that doesn't correct the problem.

[ajb1029 37]

So update-spoke with a surgeon today who recommended what I have been thinking--hernia repair and do the bypass. I had worries about lack of Iron absorption with the bypass but I found out today because I am having to use so much famotidine I basically have very little to zero acid which is necessary for absorption so famotidine is REALLY unsustainable. Also found out on fluoroscopy, my sleeve is not dilated, but I have a kink at the top, which he said is not helping the reflux on top of the hernia.

So now I need all the prayers, warm vibes and well wishes that my insurance can do the right thing and not make this a huge pain in the ass to the point I give up and go to Mexico.

Also-just to get my ducks in a row--anyone SUCCESSFULLY fight and get a revision covered for use of medical need not weight loss where it normally wouldn't be covered?
I'm not gonna lie, I'm not hopeful.

Also, does anyone have experience with and can recommend the best Mexico center for sleeve to bypass with hernia repair? Just so I have plan B.

Thanks for any insight or help anyone can give!!

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