Revision from VSG to RNY

My reflux started about 8 months after my VSG. Initially we thought it was caused by a bad gallbladder which I had removed 8 months after surgery but removing my gallbladder didn't resolve my Reflux. My reflux got progressively worse. I went from omeprazole 2x a day to protonix/omeprazole to protonix/dexilant/Zantac and nothing worked. Dexilant was the only thing that provided any relief but I still had reflux and was still coughing up acid on the dexilant. When my insurance refused to cover the Dexilant anymore I knew I had no choice but to revise. 

That's interesting. Were you taking PPIs during the first 8 months?

My surgeon told me that I may have acid reflux after surgery, but that it should get better. He said to give it some time before thinking about revision. - five more months. He is in Mexico. 

I've seen a bariatric surgeon here and he wants to see me in three months to see if it's gotten any better. He doesn't think it will and thinks I will have to convert to bypass. 

So, that's two different opinions. I'd like to see what a GI has to say. 

I haven't tried anything else besides omeprazole and dexilant, but if I'm still getting acid on dexilant - and it's supposed to be the very best (according to my PCP), if it gets any worse I'm in trouble. 

Luckily, my insurance will cover the dexilant. 

Are you still doing ok with the RNY?

My surgeon puts his patients on a PPI for the first month post op.  After that I stopped and didn't have any problems until month 8.  He thought my symptoms (chest pressure, bloating, some actual heartburn) was caused by my gallbladder.  I had that removed in Feb, 2015 and was better for about 2 months, but my heartburn came back in May and increased in severity quickly.  The dexilant was the only thing that gave me any type of relief, but like I said, I was still coughing up acid on it.  I was also tested for a gene mutation that affects the rate the body metabolizes other PPIs (Dexilant uses another pathway through the liver so isn't affected by the mutation)  Turns out I have the mutation and am an "ultra rapid metabolizer" of PPIs which helps to explain why other PPIs did nothing for me.  I don't think that the dexilant would have worked for me long term, even if insurance would have covered it, since it didn't eliminate my symptoms, just made them bearable.

There is a procedure called Stretta that you may want to look into.  My surgeon and I were considering it to control my GERD, but (1) my insurance wouldn't cover it; and (2) in the end he decided my GERD was too severe and conversion to bypass was my only option.

In my opinion (and this is based on nothing but what I went through) if dexilant doesn't eliminate your symptoms, I don't think the reflux will just stop in a few months.  But that's just me.  Maybe your surgeon is right and once your body gets used to the sleeve, it will resolve. 

I'm doing great with the RNY.  I had one incident where food got "stuck" and I never had that with my sleeve (I had a sleeve of steel . . . nothing bothered it.  That's why I was so resistant to conversion) but other than that, It's great.  It will be interesting to see if I have any food issues once I can make the next transition (saturday, I think) and start adding dense protein.  I'm hoping that since my sleeve accepted everything, my pouch will also.

I have heard of Stretta. There are several doctors in town that are listed as doing the Stretta.  I hope one of them will take my insurance if I need it. Maybe I'll have to look out of town - but I'll look into that if I have to.  

Thank you for answering all of my questions. I really appreciate it. I am so stressed out by this. The GERD seems to be escalating. My surgeon is supposed to call me tomorrow to talk to me about it. I still will ask my PCP next week to refer me to a GI. I think that's the next thing I need to do. 

-Anne 

Ann, did you switch to RNY from VSG due to reflux?  Do you still have reflux after the RNY?  I am having a bad problem and not sure if it is going to be controllable.  

I know several people who had bands out and revised to sleeves or RNY. In these cases, none of the surgeons would do a band to sleeve in one operation. They all had to wait for a few months in between. But the band to RNYers all did so in one procedure.

  After eight years I had to have band removed quickly . Have had horrible gerd for years.  Three surgeons advised me same thing so second part will be rny

I have a band and have been told by 3 different surgeons that it's best to have the band removed and wait a while before getting revised to a sleeve, because the sleeve would not be shaped right and would not function as it should due to a small upper pouch that forms because of the lax upper portion of the stoma that had been above the band. They said that portion of the stomach isn't used to being used anymore and the muscles are weak, causing it not to fumction properly. Because of this, when sleeve surgery is performed, a small little weak pouch remains at the top of the sleeve, which causes the sleeve to not perform as it should. I apologize for the repetition; I'm not really explaining it clearly, but trust me, it made soooo much sense when each of them explained it to me. My current surgeon would prefer to do a revision in one surgery but is open to me doing it in 2 based on my concerns about this. 

I have also been told by each surgeon that a revision surgeon will never be as successful as a "virgin" procedure due to the physical and metabolic changes the body has already been put through, if that makes any sense?? Hope everyone is having a great day!

Thank you for sharing, iIhave the same surgery for the same reason 4-Aug and i'm ready to get it over with. I don't need too lose to much weight, however i need to get my acid reflux more under control more than anything. I will be happy with losing 30 pounds!

Good luck!  Hope your surgery goes as smoothly as mine!