VSG - 10 Years on. Weight Gain - Reflux etc

I had the VSG in 2009. By 2014 I had severe GERD and a substantial amount of regain. It was hard to eat health because so many things exacerbated my GERD.

I went to a surgeon who discovered a sizable hernia (it was even bigger than he thought when he went in to fix it). He also offered (and strongly suggested) revision to bypass, as the best way to prevent further issues with GERD (and increase weight loss). I was strongly opposed to bypass and so he said he would fix the hernia and we would see if that resolves the issue. When he went in, he was able to "re-size" the sleeve which had also stretched or something. He said that was common with people who had the sleeve when it was a newer procedure (like you and I). So, he fixed the hernia and I ended up with a smaller stomach. That definitely helped me lose weight again. I went back to barely being able to get in an ounce of liquid, 1 egg, etc. It also helped with the GERD to a significant extent. I was still relying on PPIs after surgery and my surgeon kind of through up his hands and said well, then its as good as its going to get.

I wasn't satisfied with that answer. I didn't want to have the surgery to end up still relying on meds for forever. Ultimately, I read about PPI dependence. They create a vicious cycle, where the acid increases or something when you're not taking it, so you need to take it, whi*****reases the dependence on it (seriously, look it up). I was able to wean myself off of it and haven't taken or needed it in years. I wrote a post on it. You may be able to look it up.

You may want to ask your surgeon if he can resize your stomach. He would insert a smaller bougie and tighten the stomach around it. I believe if that doesn't work you can always end up doing the RNY later (insurance and further surgery, aside) but you can't go back to a less drastic procedure.

This was all a while ago, so if you have further questions, I can try to answer them. Hope this helps.

So a quick update. Ive had a scope, and the drs have said that my GOJ muscle ( the part that sits just above your stomach and stops reflux ) as stopped working, to the point where i have one long open stomach and so i can eat, fill the sleeve and then some and thats causing the gerd. Seems like i may not have stretched the sleeve, just killed a muscle.. Only pathway forward is an RNY, which im not keen on so have to give it some time and decide if i want the side effects of an RNY or the pain of gerd if i dont take meds every day..

It certainly seems like you have some time to decide on things. Your GERD seems to be reasonably controlled with the medication, it's just when you skip it that you have problems, is that right? It sounds like there is still some room to play with medication, diet and lifestyle tweaks to improve things without going as far as surgery - some have GERD problems that don't respond to any of these things, and they are the prime candidates for the RNY revision.

Keep in mind that every time we go in there surgically, we back ourselves into a corner a little further as far as future options are concerned, so we want to make the most of it if we go for a revision. The RNY, even in its virgin form, imposes limits on future medical treatment options and is difficult to revise should weight problems persist or reoccur or if intransigent side effects crop up (typically the marginal ulcer problem.)

I had the opportunity a couple of years ago to revise, though GERD was more of a sideshow, and at the level that yours sounds to be at - minor level of medication needed to control things, but if I skipped a dose, I would feel it the next day. Recently, I have discovered that if I skip a dose, I don't notice it until I check my pill box the next day and see that I didn't take them yesterday - so symptomatically, things have improved - will have to check with the gastro about making adjustments and following up on that.

The problem that I see with your muscle issue (by your description, it sounds like the muscles controlling the lower esophageal sphincter - the pyloric valve's opposite number) is that it doesn't seem that the RNY revision really addresses that problem directly. It will usually improve the overproduction of acid that can reflux, and reduces pressure in the stomach that can cause some reflux so it can relieve your noticeable symptoms, but doesn't correct the fundamental problem of the sphincter not keeping the stomach contents down. The couple of rare cases of esophageal cancer after RNY that I have seen referenced were a result of the basic problem that you have - the esophagus becoming an overflow stomach - so this is something that you likely will still have to contend with after a revision. You should limit meal sizes (as you should now) and monitor things endoscopically periodically to make sure things aren't deteriorating in there. There are implantable devices and other surgical procedures that are sometimes done to address this problem specifically, and that would be another avenue of investigation for you, as there may be something there that is appropriate for your situation.

Another point is the medications that are needed. Some may be overly eager to revise in order to get away from the PPI medications that are used - there are lots of scary stories on the internet about them, and ideally it is best if we can avoid medication of any kind (but our world is far from ideal.) The problem with this is that many in our RNY community here are also on PPIs to control the RNY's acid related problems - what GERD is the the VSG, marginal ulcers are to the RNY; also, GERD is not unheard of with the RNY, so opting for surgery in preference to medication that works is questionable.

It sounds like some second opinions are in order, both from surgeons and non-surgeons alike. I had one surgeon who was pushing an RNY revision pretty strongly, but other doctors offered alternatives that were worth pursuing, putting off surgery until sometime in the future, if ever. At this point it remains an option, but once the trigger is pulled, it's hard to go back. I will take things slow and monitor things before exercising that option.

Careful with Gerd. It is a potential future cancer issue. Also, when I have had issues with regain it is always associated with the acid coming back with a vengeance. Good luck with everything!

Im 7 yrs out, no gerd issues but have gained 40-45 lbs back I believe it came from knee surgery and a break up at the same time in 2015. However I was going to the gym 6 days a week for 2 hrs and then couldn't bc of surgery. soooo here I am trying to lose again. You need to go back to basics and do what you were doing in the beginning. Its not easy but you have to remember this is a tool and just bc you might get a revision it will not stop old habits from coming back once again. You have to change the way you mind thinks. Good Luck