Any Options Besides RNY for Reflux and Herniation?

Hey guys!  I'm three years out and have had some regain -- not enough to justify an RNY revision, but I seem to be one of the unlucky ones whose reflux has gotten worse.  I had an upper GI today, and have a herniation, plus my stomach is apparently emptying very fast -- the doc said, "Wow!" as I was drinking the glop, and I said, "Great!  That's just what I wanted to hear!"  And he said that my stomach was emptying really fast. 

My GI doc (now gone, so I need a new one!) and my surgeon (now gone, so I'm seeing a new one), and the new surgeon, all said that RNY would be the solution if my reflux got worse.  So, it looks like I'm heading down the RNY path -- just wanted to see if anyone had any insights. My sister had RNY and did great -- as have others I know, but it's still a little disappointing to have to go down that path.

Any encouragement would be appreciated, since I'm bummed out!

I wonder if fixing the hernia would take care of the reflux? 

I don't know if I would be real concerned about the stomach emptying fast as you were drinking and liquids always seem to leave the stomach fast, but I could be wrong.

How is your restriction when you eat dense protein does that seem to keep you full or are you struggling with feeling full?

If you end up having to go the RNY route it's not that bad.  I will tell you that after I had my band to bypass revision my heartburn/reflux was gone when I woke up from surgery and has not come back.

I was wondering the same, but I had reflux wayyy before surgery (maximum dosage of Nexium and prilosec before that, 2x a day) -- and periodically, I'd see how things went without a PPI -- but not so good!  The GI doc had recommended RNY to begine with, but I was trying to keep all my parts intact! It was a risk, but I took it, knowing this was a potential decision I might have to face in the future. 

I only have restriction when I eat eat solid chicken, turkey or pork -- not so much with ground meats, veggies, etc.  I am also concerned about taking PPIs for many, many years, and RNY would take care of that problem.  

Sometimes fixing the hernia (I assume we're talking about a hiatal hernia) will fix the reflux.  But you won't know until after it's repaired.

GERD is dangerous.  It damages the esophagus and is just plain painful.  I understand not wanting to convert to RNY, but it's a better alternative than living with GERD.

LOL -- I know!  I have had GERD for more years than I want to count.  Thus I knew going into a VSG that if my reflux got worse, an RNY might be in my future.  I take twice the normal max. dosage of PPIs and have for many, many years.  Thus, when all things are weighed, the RNY is probably the best choice.  I am just trying to make sure I check out everything I can!

I developed horrible reflux after sleeve surgery.  I've had a UGI, Manometry and 24 hour pH study, which showed significant reflux and an esophagus that really isn't working any more.  My surgeon has recommended a procedure called Stretta to remodel the thickness of the lower esophageal muscle and prevent acid from flowing back up.  It was either that or revise to bypass since my symptoms are uncontrolled on meds (protonix 40mg/dexilant 60mg/zantac 150mg a day).  Hoping to schedule soon so I can avoid another surgery.  Good luck!!

Oh, I also don't know if I would be concerned about my stomach emptying quickly when drinking just liquid (even barium).  I watched my Barium swallow and liquid flowed straight through without stopping.  If your restriction is good when eating dense protein, I wouldn't be concerned.

Thanks!  

I just went though this, but not with a revision to Rny. This past December the upper GI confirmed that almost all of my stomach was herniated and up in the chest cavity. I was having my gallbladder out, so the surgeon took care of all if it at the same time. He fixed the hernia, put in a mesh to hopefuly keep it in place, and took out the gallbladder. To be honest, I am not sure it worked. I am still a little symptomatic, still have a ton of reflux, and still have some of the other symptoms such as burping a lot, acid issues, occasional nauseua, pills/food getting a little stuck, etc. I have a follow up in a while again to see where it is at. My surgeon did indicate that Rny would be an option to attempt to get the reflux managed. He also said the second hiatel hernia surgery is much riskier, so no idea what that would mean for number 3. The revision would for sure better than letting the acid issues run amuck, as it can cause precancerous and then cancer of the esophogus or Barrets syndrome. Then again, that opinion is coming from the chic with cancer and with a history of sacraficing a multitude of body parts to keep it at bay. Good luck and let us know how it turns out. 

Thanks!  I'm thinking the same thing, and I'll let you know how it goes.  The appt with the surgeon isn't until March 29 (unless she has a cancellation) and I'm not sure what the process is for this, but she did tell me that it was quicker, since this isn't "weight-loss surgery" per se. LOL -- once I get resigned to the fact that I have to have it, I'll probably want it immediately! Then I could take my time when the weather was nice!

Implicitly, you are in the LA area, based upon your surgeon's listing, which is good thing in this case. In your situation, it would be worth getting a second opinion from Dr. Ara Keshishian (he's in Glendale.) Being a long time DS surgeon means he has much more experience with sleeves than average in the bariatric world, and he is one of the handful of surgeons around with the chops to handle the complex RNY/DS revision. He is also rather anti-bypass, (which is good and bad...) so if anyone can work out how to resolve your problems without resorting to a bypass, it is Dr. K.