Revision to RNY

Hi everyone.  I'm almost two years post VSG.  I'm one of the unlucky few who developed horrible GERD post surgery, after never having a problem with reflux pre-surgery.  I'm currently discussing potential treatment plans with my surgeon and he asked me to seriously consider revision.  It's a hard decision for me.  I LOVE my sleeve . . . I have lost 130 lbs, I have zero food issues, can eat all types of protein without issue, etc.  But my acid is BAD and my insurance company won't approve either the meds that keep it in check the best or other less invasive medical procedures.  We're not even sure if they'd approve revision for me, but I had to agree to put the option back on the table. I've done a lot of reading here and have a few friends who have RNY and it seems like there are more incidences of food intolerance with the RNY than with the sleeve.  To help with my decision (or maybe to make it harder), can you let me know if you have any problems eating dense protein or any other type of food; if so, what are the problems (trouble getting the food down, sliming, etc.) and how far out you are.  Thank you in advance for participating in my completely non-scientific study!

HI Stacy!

I'm not a revision, but one of my really good RL friends revised from the sleeve. She had her sleeve in March 2015 and instantly had trouble. She didn't have GERD, but everytime she ate her stomach twisted on itself causing severe pain and nausea. She even had a hard time keeping fluids down.

After trying a few different procedures that didn't work, they revised her to RNY in August, the day before my RNY. We've talked in depth about our experiences, and hers is a lot different than mine. I don't really have lactose issues, and don't dump on sugar. She has both lactose intolerance and dumping. That makes her very careful about eating sugar and dairy. She doesn't have any problems at all with sliming or dense protein, and eats steak and chicken regularly. I don't know that her sensitivities have anything to do with the fact that she was revised, or if it's just how she would have been if she had decided to have RNY from the very beginning. I do know she's below her goal weight and very happy with the ability to eat again. Take that for what it's worth, since you don't have the same issues that would cause a need for a revision.

Either way you go, with revision or just trying to manage your GERD, I hope you find some relief.

Thank you!  I'm so afraid of the food tolerance issue.  I had a long talk with my surgeon this morning about that and he agrees it could be an issue.  I absolutely LOVE my sleeve for that reason.  I've been eating steak, chicken etc. with no problems since the day I was cleared to advance my diet.  As a result, I've never had a problem meeting my protein goals.  Everyone here has done so well with their RNY, but it frankly scares me since I've had it so good for so long.  We're going to fight my insurance company's denial of benefits so I can at least try the less invasive procedure (or I might just do it anyway and pay out of pocket) since the revision scares me so much!  Thanks for your response.

I had the lap band in 2008 and in 2013 I started having terrible GERD and acid reflux so bad that I couldn't even lay day to sleep.  Most of the time I had to set up on the couch or chair to sleep.  I ended up having all of the fluid taken out of my band and still had the problem.  After some tests it was found that the GERD and acid reflux was then causing me to have esophageal ulcers.  My surgeon told me she had to take the band out as it would only get worse from there.  I truly went into a panic and depression as I had already gained most of the 85 lbs that I had lost back and I wasn't sleeping or eating right due to the issue. 

I wanted to get the revision to the sleeve as it was less invasive and not the "malabsorption" procedure.  My Dr told me she wouldn't do the sleeve for me due to the problem with a lot of sleeve patients getting GERD and my insurance would not approve the sleeve for me in revision.  She did recommend the RNY and my insurance would approve that for me.  I did go ahead with the RNY on Sept 1 2015. I am 6 months out.  I immediately felt a difference from the moment I woke up from surgery and they had me drink some water.  The band was gone the RNY was done. There was no burning in my chest and the water went down with no problem.  I have not had ANY issues with GERD or acid reflux, I sleep through the night and I just feel 100% better and the ulcers are gone!!!  

I do have a low tolerance for sugar which is not uncommon with RNY patients.  When I eat dense protein I don't have to eat as much to get full.  I don't eat a lot of beef or pork because that didn't work for me when I had the band.  I have tried it but since I went so long without it my tummy doesn't feel to good when I eat it so I don't.  However, I have been able to eat a crispy piece of bacon from time to time and that I really appreciate. 

I don't tolerate fried foods very well but since I have had this surgery it doesn't even smell or sound appetizing to me. 

I have found I can eat more vegetables now than I did and that is a nice change to get something fresh.

Hopefully this is helpful 

Thanks!  Glad your revision is working for you!

i am so happy to read this for myself! i had my band removed because of all the issues you stated and was a little nervous about RNY and getting GERD again- b/c the day they took the band out - it all stopped. I have had tums maybe 3 times in 2 years since the band was removed. I was a bit worried b/c they put everyone on PPIs for RNY for a year. praying there is no GERD after that.

I too was told that i wouldnt be a good sleeve patient b/c of the band experience. 

If I had GERD pre-surgery I never would have gone with the VSG.  My GERD is horrible.  I did a 24 hour pH study in January.  Normal acid levels are considered 14.72 or below, a higher number is evidence of reflux.  My number was 75.4.  Out of the 22 hours I was wearing the probe, I spent almost 5 hours in active reflux.  If I had any inkling how bad it could be, I would have gone with RNY from the start.  My surgeon told me I am likely to have full resolution of my symptoms if I choose to revise.  Good luck!

Problems eating dense protein? You're kidding, right? Cows fear me.

Set aside temporary problems you might get in the first month or two. Any surgery is prone to sliming and things like that the first couple of months. Long term, there is very, very little difference between the two surgeries, as far as what you can eat, how much you can eat, and how much you will lose.

Differences.

1. There's a small percentage difference in tolerance to sugar. People talk about dumping a lot. Very, very, very few dump on small amounts of sugar. It takes a lot for about 30% of RNYers to dump. And if you eat that much sugar -- stop it. The other 70% will never dump at all. I did it once in 3-1/2 years, and it was my fault. I won't do it again.
2. Reactive hypoglycemia. Starting a couple of years after RNY, if you eat too many simple carbs, like sugar, starches, bread, you can get a low blood sugar episode a couple of hours later. If you eat right, and have a mix of protein, fats, and carbs, it is easily avoidable. It's all on us.
3. Vitamins. Because of the bypass, you have to be aware of your vitamin and mineral levels. Getting good labs done every year is really important. Now, this is true for VSG also, but it can be more of a problem with RNY, but ONLY IF YOU IGNORE IT. take your vitamins, get your labs done, make adjustments, and it's not a big deal at all.

That's pretty much it. Having said that, I know a few VSGers that say they dump on too much sugar, and many can have blood sugar issues from simple carbs. Both surgeries can have problems with too much fat, but it's rare, and seems to be in about equal numbers.

There's nothing that most of us can't eat, and really nothing that any of us can't eat in moderation.

I know two people in my local support group that developed horrible gerd after VSG. They were miserable. An, they were in danger from other, worse problems, like esophageal cancer. And there are new studies coming out about the long term effects of taking PPIs, and it isn't good. They both revised to RNY, lost the rest of their weight, and got rid of gerd 100%. They are ecstatic.

Well, I knew you didn't have any problems with protein.  I'm hoping to stay that way.  I have no problems with beef, lamb, chicken, pork, etc.  I also stay away from breads, rice and pasta so RH really isn't a huge concern.  It's really the protein that's holding me back!  I need my animal products!!!!

I hear you on the long terms PPI use also!  Given genetics and a family history of dementia, it is a concern.  The best scenario is that we can convince my insurance company to allow the less invasive Stretta procedure in the hopes that it will resolve my GERD.  That way I can keep my beloved Sleeve.  If not, you all have gone a long way in making me feel more comfortable with a potential revision.

Get tested for food allergies.  I am allergic to dairy (proteins) , soy, and few more ..and if I ignore taht - the GERD is horrible.  Yes - I have GERD with RNY.. and i did not have that before...