What am I missing? Questions regarding the DS and GERD

Hi all, 

I was hoping someone had an answer for this. I have the gastric sleeve and severe GERD. Because of this I have been told to get an RNY.

From what I have been told, GERD is a fairly common side effect caused by the sleeve. And from what I can ascertain, a sleeve is about half of what a duodenal switch surgery is (the restrictive part). Now the sleeve board and the revision board are full of people like myself, with heartburn from another realm. But I'm not seeing that here. Ive read that people with a history of heartburn shouldn't consider the DS but many people with the sleeve didn't have reflux issues prior to being sleeved. If the sleeve is a high pressure system that is responsible for excessive reflux then why am I not seeing people with the DS suffering from the same thing?

Also, if you do get it, DS to RNY sounds like a risky and very rare surgery, how is it usually treated? 

Any insight here would be greatly appreciated. 

Thanks! 

The reason GERD is so much more of an issue with sleeve than with DS is that many sleeve surgeons make a very tight sleeve, whereas most DS surgeons make a looser sleeve. With the DS, the malabsorption helps both with weight loss and esp with maintenance of weight loss. With sleeve, when it first started being done as a stand alone, weight regain started after just a few years (and/or patients never lost weight well to start with) so they started making tighter sleeves in the hopes of preventing this. In reality, any sleeve is going to stretch over time, though never back to the original stomach size, so making a really tight sleeve probably only postpones weight regain rather than preventing it. Meanwhile, it causes GERD, which can be severe and can be difficult to deal with because they isn't much stomach left to work with. I'm very sorry this is happening to you.

I would recommend consulting with a surgeon who does the DS before revising to RNY, so that you learn about all your revision options. DS revision to RNY is extremely rare. I know of one or two people who had it done to deal with some kind of complications of their DS. RNY to DS revision is not common either, but certainly more common, because there are a good number of people who either never lose enough weight or suffer from major regain with RNY despite their best efforts, or who experience serious problems with dumping. This is also a risky surgery, and should only be done by a very experienced DS surgeon who is familiar with these complex revisions.

Larra

I think Larra is spot on.  The only DS surgeon that I've seen talk about this is dr. Kesheshian out in California and that may be just because he does a lot of outreach not an indiication that other surgeons couldn't handle it just as well. I'm sure it's a mixed bag some can and some can't.

I'm not sure this will be any help but Dr. K has this video on GERD and you can search his blog posts although a lot of it the mentions are minor about GERD.

https://www.dssurgery.com/videos/gerd-surgical-treatment/

Pete

I have a variation of the DS called a SADi DS whi*****ludes a longer common channel than a standard DS. The SADi procedure is really an updated RNY. Since having it done, I've lost more than 100% of my goal, and have no gerd issues.

Everyone reacts differently but that is my experience.