Kim M

Sleeve to bypass due to GERD

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I will be 6 years post op in June.  I began having an increase in symptoms of GERD in Nov 2017.  I met with a gastro and my meds were increased and I am on a very bland diet.  Symptoms are a bit better than the medication change but still awful.  What concerned him was the coughing at night as he said the acid was going into my bronchial space. The only solution was a revision to bypass.  I am not surprised this is his recommendation but I just can't rap my head around this yet.  I don't know why having bypass surgery scares my so much.  I had gone for a consult 10 years prior to having the gastric sleeve and won't do it. Any anyone share their experience if you have been through this.  Also would welcome any information about having bypass surgery and your experience with it.  TIA

Kim. 

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I'll chime in here but with the caveat that my revision wasn't from sleeve, rather it was from the very old fashioned Gastroplasty. That surgery was pretty much a horizontal staple line across the stomach with a small opening into the remnant stomach....it worked a bit like a lapband I guess only the opening was fixed rather than adjustable. It was horrible GERD that resulted in me having my first endoscopy, which is also where my problems were first spotted, ie stapleline dehiscence. I was fortunate in that the surgeon that did that endoscopy was head bariatric surgeon at one of the largest teaching hospitals in my state so he knew what he was looking at. Eventually he did offer me a revision to RNY....I say "offered" because he worked in a govt funded hospital and my surgery was a complete freebie. 

There are lots of things to consider going into a revisional WLS. Complication rates are higher, particularly leaks which I've seen reported as much as 20x higher than with original WLS. I believe the issue is to do with having to staple over existing scar lines and still get full adherence. The surgery is generally much longer in duration and part of that is often needing to deal with adhesions in the abdominal cavity that may have occurred as a result of the original surgery. There is also a much higher rate of conversion to an open incision rather than a completely laproscopic procedure. Mine was completed laprascopically but took two surgeon's nearly 4 hours to complete.

As for the result, I've been reflux free since surgery. The issue that caused the surgeon and other medical personnel most concern post surgery was stopping weightloss rather than losing weight. I was considered quite low BMI at the time of my surgery. The revision will result in further weightloss, and it does need to be closely monitored in those patients who wouldn't normally qualify for WLS. The only real issue I have post surgery is hyperinsulinemia, aka reactive hypoglycemia. I've just been prescribed Metformin to try to control my insulin release. In lesser cases they might just leave people to sort that issue with diet alone, but unfortunately my uncontrolled highs and lows has caused other ongoing problems, eg poor rate of healing after a foot surgery and now ongoing highly resistant  thrush issues. The decision was taken by my gynaecologist to use metformin to try and get this problem resolved.

I've never regretted having my revision. I've attained a healthy BMI for the first time in my life. I'm reflux free now. The only complications in reality have been more of a frustration value than anything else. I know these things too will pass. I'd prefer they'd hurry up, but they are very minor in the scheme of things. Good luck making your decision. I'm happy to answer any specific questions you might have, if I can.

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Can you tell me how long after revision did you feel relief from reflux? I am going on 3 1/2 weeks Since my sleeve to bypass surgery and I’m still having symptoms

 I just don’t know if I’m being impatient or it might not have worked 

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I'm sorry you're still dealing with acid reflux Alijane.  Have you spoken with your surgeon about this?

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I thought I responded last week.  Sorry for the delay but don't stop by that often.  I am 9 months post revision surgery.  The GERD gets better.  I really don't recall how long it took to feel relief but it must have been fairly soon as I went form 4 PPI's to 2 fairly quickly.   I currently am taking one pill a day in the morning.  I still can't eat anything spicy and tomato sauce is beyond painful.  I did have hopes of being off all medication but that has not happened.  I don't eat after dinner and still have to sleep on 2 pillows at night.  I probably was not a great candidate for the sleeve as I had GERD before the surgery.  My surgeon didn't think it would be a problem.  Hope things are improving for you.  

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I had an original revision to sleeve from band about 4 years ago, and wish I had known that GERD this severe was such a common complication.  I am having revision to bypass next Friday, which hopefully will be the LAST.  I never wanted a full bypass, but I would have elected to go directly to one if I had any idea.  I am pleased to see people saying that the GERD improves! 

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42 minutes ago, eladams2015 said:

I had an original revision to sleeve from band about 4 years ago, and wish I had known that GERD this severe was such a common complication.  I am having revision to bypass next Friday, which hopefully will be the LAST.  I never wanted a full bypass, but I would have elected to go directly to one if I had any idea.  I am pleased to see people saying that the GERD improves! 

Welcome to Thinner Times!

I'm sorry you're having to have a revision. 

I have never had to deal with GERD but I've been around this forum long enough to know that it's not something you'd wish on anyone.

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2 hours ago, eladams2015 said:

I had an original revision to sleeve from band about 4 years ago, and wish I had known that GERD this severe was such a common complication.  I am having revision to bypass next Friday, which hopefully will be the LAST.  I never wanted a full bypass, but I would have elected to go directly to one if I had any idea.  I am pleased to see people saying that the GERD improves! 

Wishing you a speedy recovery and  relief from your symptoms. 

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On 8/4/2019 at 11:23 AM, Kim M said:

I thought I responded last week.  Sorry for the delay but don't stop by that often.  I am 9 months post revision surgery.  The GERD gets better.  I really don't recall how long it took to feel relief but it must have been fairly soon as I went form 4 PPI's to 2 fairly quickly.   I currently am taking one pill a day in the morning.  I still can't eat anything spicy and tomato sauce is beyond painful.  I did have hopes of being off all medication but that has not happened.  I don't eat after dinner and still have to sleep on 2 pillows at night.  I probably was not a great candidate for the sleeve as I had GERD before the surgery.  My surgeon didn't think it would be a problem.  Hope things are improving for you.  

Kim how are you doing now?  Do you have any regrets?  My Gerd gave me esophagitis grade C and they want to do the bypass on me Feb 26th(that is when I am scheduled for surgery) if I don't chicken out.  How much more weight did you lose and where did you end up as far as weight?  Are you off all the meds now?  Do you feel much different from VSG to Bypass with what and how you eat?

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Hi Tracy,  Sorry to hear that your GERD has not gotten any better.   I am a little over a year post-op.  I still have GERD...although not as bad as before the revision.  One to two protonix a day and nothing spicy.  As I mentioned, anything with tomato sauce has me doubled over.  This is a very different surgery experience.  It is a different type of restriction.  If i eat a mouthful more than I should, I vomit.  I am having trouble with solid protein.  About 2 ounces of fish is all I can get down and a mouthful of veggies.   I was able to eat chicken a few months after surgery, but not anymore.  I have added more carbs as they go down and stay down...think soup.  I lost about 50 pounds and am maintaining now.  I did want to lose another 20 but I am not stressing about it.  As you know GERD can cause changes in the esophagus which can be dangerous.  I was resistant to have the surgery, but in the end did it to prevent further damage. Feeling pretty apathetic about food right now.  It is a difficult choice, but unfortunately necessary at times..  Wish you well  Keep me posted. 

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4 hours ago, Kim M said:

Hi Tracy,  Sorry to hear that your GERD has not gotten any better.   I am a little over a year post-op.  I still have GERD...although not as bad as before the revision.  One to two protonix a day and nothing spicy.  As I mentioned, anything with tomato sauce has me doubled over.  This is a very different surgery experience.  It is a different type of restriction.  If i eat a mouthful more than I should, I vomit.  I am having trouble with solid protein.  About 2 ounces of fish is all I can get down and a mouthful of veggies.   I was able to eat chicken a few months after surgery, but not anymore.  I have added more carbs as they go down and stay down...think soup.  I lost about 50 pounds and am maintaining now.  I did want to lose another 20 but I am not stressing about it.  As you know GERD can cause changes in the esophagus which can be dangerous.  I was resistant to have the surgery, but in the end did it to prevent further damage. Feeling pretty apathetic about food right now.  It is a difficult choice, but unfortunately necessary at times..  Wish you well  Keep me posted. 

Thank you Kim.  Are you saying you can only eat 2 oz of fish and a mouthful of veggies at a year out?  Where did you land as far as weight?  Were you trying to lose ?  He said I will lose and then go back up and level out.  I can stand to lose 20lbs more but he is saying I will lose 40 to 50, I suppose if I bounce back to 150 that might be okay.  I had got down to 164 this summer and my face was looking pretty thin, ugh lol .

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6 hours ago, tracyringo said:

 He said I will lose and then go back up and level out.  

That's about the same the surgeon said to me. 

Should I opt for surgery they would revise the anastomosis in the same sitting. He talked about an additional 10% weight loss (that would be about 6 to 6.5 kg in my case), that many patients gain back within the first year. However, some lose more and some less, some don't gain back, some only a bit. 

What I have to ask about is additional malabsorption in regards to nutrients, now that I think about it.

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6 hours ago, summerset said:

That's about the same the surgeon said to me. 

Should I opt for surgery they would revise the anastomosis in the same sitting. He talked about an additional 10% weight loss (that would be about 6 to 6.5 kg in my case), that many patients gain back within the first year. However, some lose more and some less, some don't gain back, some only a bit. 

What I have to ask about is additional malabsorption in regards to nutrients, now that I think about it.

Malabsorption of nutrients is what I fear also.  Its all quite a bit to think about.

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I don't have that much problems with MGB (have to take quite a bit of calcium and vitamin d though). However, the small intestine will get a bit shorter so bile can't flow back. They usually take at least 50 cm, if the small intestine will remain long enough they will take 70 cm.

I'm hoping for a still-long-enough small intestine so I can get the 70 cm to prevent bile reflux once and for all (or so they say...).

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19 hours ago, tracyringo said:

Thank you Kim.  Are you saying you can only eat 2 oz of fish and a mouthful of veggies at a year out?  Where did you land as far as weight?  Were you trying to lose ?  He said I will lose and then go back up and level out.  I can stand to lose 20lbs more but he is saying I will lose 40 to 50, I suppose if I bounce back to 150 that might be okay.  I had got down to 164 this summer and my face was looking pretty thin, ugh lol .

The amount I can eat differs each day.   A good day is being able to eat both protein and vegges together.  I had regain so the weight loss was a plus.  My surgeon said I would lose about 20 pounds and after the first year probably gain it back.  I lost more and so far am maintaining,  I did not have a full bypass as if it was an original bypass surgery.  He connected further up so I wouldn't have as much malabsorption.  So far my vitamin levels are all good and honestly I am not great about taking vitamins.  

With no pyloric valve I thought I would be able to eat more but this has not been the case.  I guess that is why soup is easy as it slides trough the pouch.  Hoping this is the last bariatric  surgery I will ever have to have.  I am almost 65 and honestly done.  I started this process 7 1/2 years ago and would like to eat small portions without throwing up.  This really was not an issue with VSG.  I guess each surgery has its downside.  

Again,  I wish you well and am here to support you with your upcoming surgery.  

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2 hours ago, summerset said:

I don't have that much problems with MGB (have to take quite a bit of calcium and vitamin d though). However, the small intestine will get a bit shorter so bile can't flow back. They usually take at least 50 cm, if the small intestine will remain long enough they will take 70 cm.

I'm hoping for a still-long-enough small intestine so I can get the 70 cm to prevent bile reflux once and for all (or so they say...).

I haven't heard about bile reflux.  Would you expand.  Thanks.

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7 hours ago, Kim M said:

The amount I can eat differs each day.   A good day is being able to eat both protein and vegges together.  I had regain so the weight loss was a plus.  My surgeon said I would lose about 20 pounds and after the first year probably gain it back.  I lost more and so far am maintaining,  I did not have a full bypass as if it was an original bypass surgery.  He connected further up so I wouldn't have as much malabsorption.  So far my vitamin levels are all good and honestly I am not great about taking vitamins.  

With no pyloric valve I thought I would be able to eat more but this has not been the case.  I guess that is why soup is easy as it slides trough the pouch.  Hoping this is the last bariatric  surgery I will ever have to have.  I am almost 65 and honestly done.  I started this process 7 1/2 years ago and would like to eat small portions without throwing up.  This really was not an issue with VSG.  I guess each surgery has its downside.  

Again,  I wish you well and am here to support you with your upcoming surgery.  

He connected further up?  I wonder why they don't all do that ?   Although my surgery is scheduled for 2/26 I am still not sure I am ready to do this, but I think I would feel better if I could have the same done to me if it helps with the malabsorption .

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9 hours ago, tracyringo said:

He connected further up?  I wonder why they don't all do that ?   Although my surgery is scheduled for 2/26 I am still not sure I am ready to do this, but I think I would feel better if I could have the same done to me if it helps with the malabsorption .

Obviously, not the medical terminology for how my surgery was done.  I had asked my surgeon if he was going to do a mini bypass and he said no.  However, he said he would not bypass as much intestine.  This is probably why I haven't shown any malabsorption issues. Not yet anyway.  I am going to have my vitamin levels checks in February as well as a bone density test.  I will know more then.  

I understand how you feel about the surgery.  I did not want to have another surgery.  I had my concerns about bypass. I have not seen my surgeon since my post op visit.  My endocrinologist does all my testing.  I probably should be scoped to see if anything is going on as it does seem strange that I can only eat small amounts  This has led to eating every few hours at times.  I think the reason I have stopped losing weight is the addition of carbs.  As I mentioned, they seem to go down easier. 

I waited a year before I finally agreed to have the surgery.  My surgeon said I was lucky I did not end up with Barretts.  VSG is a high pressure surgery and bypass is low pressure. i don't know if there are any other alternatives.  Be happy to answer any questions that you might have in the upcoming month.  

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I guess I should not be too surprised on the small amount you can eat.  I was eating small amounts with the sleeve until the 2 year mark and now I can eat 4 oz of protein without too much of an issue.  I can also eat more carbs when it comes to amounts but now with the holidays over I have went back to my protein first. I did bounce back up to my original goal weight but am on my way back down weighing in at 175 this morning.:D

I do feel a lot better knowing about the bypassing of less intestines and will be asking about that.  I going to make an appointment to go see his NP and write a list of questions. I was not prepared when I went in to see him on the 2nd. I am also still debating on cancelling the surgery and making some changes to see if there is something I can try before proceeding with it and I am hoping she can help me with that.

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17 hours ago, tracyringo said:

I do feel a lot better knowing about the bypassing of less intestines and will be asking about that.  

"Revision weight losses" can be quite disappointing for the patients pursuing it for additional weight loss or because of regain as the expected weight loss is usually not that high. I wouldn't worry about losing too much weight, even if you might experience a dip because of the immediate post-op diet.

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