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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