Sleeve vs, RYN for "Prominent Acid Reflux"

GERD, even the silent type, can lead to esophageal damage and, eventually, esophageal cancer. Recent studies have shown that long-term PPI usage is a) dangerous and b) not effective at preventing cancer.

If I were you and making this decision with the information I have now, I'd go with RNY.

In general, the malabsorption with RNY is not a big deal. Sure, you won't absorb vitamins as well, so that's why you take the recommended supplements. (Most of us take a multivitamin, plus additional calcium and iron.) Supplementation guidelines are the same for RNY as for VSG, so it doesn't really make a difference.

I'm going to give you some first hand experience. I had VSG in May 2014. I Never had any reflux prior to surgery. About 8 months post surgery, I developed a severe case of reflux. I was forced to undergo testing including a barium swallow, a pH test and Manometry which involved having a probe threaded through my nose, through my esophagus and into my stomach, where it was then slowly moved so they could test the strength of my swallows and the LES. That probe was then removed and a smaller one was inserted (the same way) and left for 24 hours so they could measure my reflux episodes and my acid. Turns out I had acid 409% higher than normal. 409%. All caused by the VSG. I would cough up acid while asleep and while exercising. It got so bad that I could only sleep sitting up. I was put on 4 different PPIs, only one of which worked but was not covered by insurance and would have cost me close to $600 a month if I had decided to stay on it. I revised to RNY as it was the only way to cure my reflux.

I know everyone and every doctor is different, but my surgeon WILL NOT perform RNY on someone with a reflux diagnosis. And your reflux is not silent. You say that you can't be active after a meal and your chest hurts. Those are symptoms of reflux. Is it possible that you could have VSG and your acid will not worsen? Sure. It's also possible that you'll end up with acid splashing back up your esophagus which will cause lesions and a whole host of other issues.

Is it also possible that you will be one of the few people who has issues with malabsorption? Sure. I guess what I'm saying is that had I known then what I know now, I never would have had VSG.

Clearly it's your decision but I wouldn't let a fear of a complication (malabsorption) that more likely than not won't happen dissuade you from what may be the better surgery for you.

After 25 years with reflux caused by VBG gone bad, and no doctor willing to correct the problem, I ended up with Barrett's Esophagus and pre cancerous lesions that must be checked every year. I too had to sleep sitting up and I had painful acid burns the size of dimes in my mouth. I would NEVER go forward with a VSG surgery that might make reflux worse when RNY could cure the reflux. My revision to RNY cured the reflux. I woke up from surgery pain free for the first time in 25 years. I can keep ontop of malabsorption with proper vitamin supplementation.

Esophageal cancer is not something you want to deal with.

Thank you all so much for sharing your stories. I've done some soul searching and am definitely leaning towards an RNY. I will be discussing this with my Dr. at my next appt. What has scared me away from the RNY is the idea of malabsorption. We had a family friend that had an RNY maybe 15-20ish years and ended up with the worst case of malabsorption her Dr. ever worked with. She passed a few years ago after many years of battling through her issues (she was literally on her death bed 10 times where Dr.'s told the family to say their goodbyes). I do know that she continued to smoke and didn't eat well when she did eat so she had a lot of things that contributed. But of course I think of her. I know the surgeries have become way more advanced and I'm the type that stays on top of my medical issues so I'm feeling way more confident in going with the RNY. Thank you all again.

keep in mind that bypass surgery has vastly improved since then. They're almost all done laproscopically now, and there's a lot of long-term data on the surgery now so they use different techniques to avoid some of the problems people used to have. Stories like that one are exceedingly rare now - so much so that I wouldn't even worry about it. There's a much greater chance that you'll have acid issues with the VSG than malabsorption problems with the the RNY. I had reflux pre-surgery - no way was I going to risk having it get worse (and it may not have - but I wasn't willing to take that risk, since it does happen to a lot of people). I went with the RNY and have been very happy with it.