Hiatal Hernia, Considering DS

Hello,

A year ago I posted that I was having issues with consuming proteins, 12 years after my VSG. After many tries to figure out what's happening, we discovered ulcers in my stomach and esophagus. After a recheck, new discovery of a hiatal hernia (small, but I am feeling so many symptoms from it now). 13 years out, and I'm hearing that I don't have enough of a stomach from my sleeve to repair the hernia, and I should consider the DS. Anyone else experience this? I suppose the bonus is I could lose more weight (initially dropped around 90 lbs, but have gained back 40 in recent years no matter what I did to keep it from happening). Wondering if anyone else out there has battled further, experienced difficulties and now looking at another form of bariatric surgery to help fix things.

Thanks!

I'm sorry that you are having these problems, but it is good that you are finding things out. Who did the checking on you (presumably an endoscopy) - a general gastroenterologist or bariatric surgeon that you consulted? Where are you hearing that you don't have enough stomach to repair the hernia? This is one of those maybe you do, maybe you don't things, and it depends both upon your particular condition, and the surgeon's experience and skills. The classic hiatal hernia repair for normal people is a Nissan fundoplication, and you right in that since much of our fundus has been removed for the sleeve, there may or may not be enough left to do a viable Nissan. Some surgeons can do it, while others can't.

The ulcers, and whatever other problems in your stomach and esophagus are often a consequence of the sleeve, whether in general or yours specifically. Many surgeons simply go for an RNY revision when faced with this, sometimes because it is the best approach in a particular case, sometimes because it is the best that they know how to do (while others may be able to correct the sleeve.) Simply changing to a DS won't do much for the problem a the DS uses your existing sleeve; a resleeve may or may not be done when doing this revision depending what the existing sleeve needs (but sounds like it would be appropriate in your case.) The DS would be most appropriate in correcting your regain problem and helping to maintain things the way they should be (assuming that it is appropriate for your other problems.

Who is the surgeon that you are working with (if you are), as there are a couple of good ones in the Bay area to handle this type of problem? In general, I am a big fan of second and even third opinions, particularly for revisions, as the causes for their need are more varied than for our original WLS, which means there can be a wider variety of possible solutions for the problem(s) and varied opinions on which is the best approach based upon different experiences that each surgeon brings to the table.

Good luck in getting some answers!

Hello,

Let me try to answer all of the questions as I understand so far. I've had 2 upper endoscopies. One in September which found the ulcers, another in December to verify if things are improving and when the hiatal hernia was found. I only started to feel uncomfortable heart burn/reflux symptoms following my December endoscopy. Then early February I had a barium swallow to see if that hernia was still prominent and verify how my esophagus was reacting. At this time I was referred to a surgeon who specializes in repairing such hernias. There is concern that my sleeve is nice and trim but also worry that over all this time, I have too much scar tissue on the outside to work with without turning it into a major surgery or failed repair in as little as 5 years.

The suregeon *****commended the DS doesn't perform gastric surgeries and referred me to another doctor (Zare) who I have an initial consult with this upcoming week. I'm waiting for this other surgeon's input on next steps, and he's come highly recommended by multiple doctors now. I will definitely review my options, and since my sleeve has failed me for the long-term despite the continued work I've done (exercising and watching my foods), and the various tries of adjusting my diet to drop down increased gains again, another form of bariatric option that fixes things and has the bonus side effect of weight loss again may be beneficial.

why do you say your sleeve has failed you since it is still"nice and trim."

Hello,

Yes, the sleeve helped me lose roughly 90 lbs, bringing me within 10 lbs of a good and healthy weight, but my regain - even though I am still careful of what I eat - has been about 40 lbs in the last couple of years. I'm back in an unhealthy weight range, and now with added complications. This is why I said the sleeve failed me.

:)

may I ask what a days menu looks like for you?

The past year has been difficult, as I've grown into some sort of aversion to most proteins and have become mostly vegetarian. Eggs and bacon seem fine, but any other meats or seafood feel like rocks in my stomach. This is how we eventually learned about my ulcers and then hiatal hernia. I have been able to maintain my weight though the past year.

Before that, my meals consisted of lean meats/eggs/seafood, veggies and minimal fruits or carbs (ie, breads, rice, etc). Lattes and favored waters or teas. Pretty much my overall lifestyle. Calorie intake would vary 1100-1600 a day. Still have a sweet tooth, but would keep it in check by saving up for special occasions or compensating exercise or reduced calories elsewhere. Tried going up and down at times when I seemed to be stuck with my weight, tried replacement shake meals and other tricks here or there to try and lose sudden weight gain that started a couple of years ago. Exercise habits before the hiatal hernia was 4-6 times a week, varied activities. Have heavily been forced to adjust the last couple of months.

I have seen a number of people on these forums who have gone through Dr. Zare and he seems to be well regarded, though I have no personal experience with him; I am not aware of him doing the DS, though he may now be doing the newer SIPS/SADI/Loop DS which is a somewhat different animal. My above comments still apply regarding possible RNY revision vs. sleeve repair or DS.

As above, I wouldn't want to go into something like this without an alternate opinion or two. You often get into the situation where Dr. 1 says that Plan A surgery is tricky in your case so I would go with Plan B; Dr. 2 may say that Plan A is no problem, we do that all the time, or he may say the same as Dr. 1, that Plan B is the better choice in your case, which makes things easier and more comfortable for you on a decision (or he may advocate Plan C - which gives you more options to consider, etc.) But it all gives us a better idea of what can really be done in our specific case and not just reading what has been done for others in similar, or not so similar cir****tances.

There are several guys that I could suggest for a second opinion, all of whom come out of the DS world. Drs. John Rabkin, Greg Jossert or Paul Cirangle are in different practices, but all up in SF proper, and could give a good view on the viability of repairing your sleeve and/or revising it to a DS; Rabkin I am most familiar with as he did my VSG and I know that he does quite a few complex surgeries such as the RNY to DS revision and liver transplants, so he wouldn't be intimidated by a sleeve repair that might be a bit more complicated than usual. While they are all primarily DS/VSG docs, I don't think any of them would hesitate to tell you that the RNY is the best approach if that were the case - they are all perfectly capable of doing that even if it isn't their preferred procedure.

On the regain side of your problem, I have seen many over the years in our support groups who have overcome upwards of 30 lb with little problem - it takes a few months but is "do-able" much like a normal person. 40-50+ lb is more dicey, with some being able to recover that while others need some revision. If only the sleeve is redone, or is revised to an RNY, you can probably figure on losing 20 lb from the surgery itself (basically what one would expect from having to go through all the pre/post op diet restrictions again) with the rest being more individual effort. The DS is somewhat more powerful than that, but may still take some work on your side, but its regain resistance is better, which is really its strong suit.

Thank you for your thoughts and experiences. I do have a second opinion scheduled for tomorrow, so I'll see if things align to the first surgeon, or if it will give me other food for thought. Either way, it would be nice to improve all of the angst with my stomach the past year. Additional weight loss as a result would be a bonus right now. :)

Just out of curiosity, what was the result of the 2nd opinion?