GERD/Acid Reflux - Reality vs Imagination

There can be other considerations.  RNY is not a good option for me because I need to be able to take NSAIDs and steroids for my rhematoid disease.  Because my reflux was likely caused by weight issues, and was controlled with medication prior to surgery, my surgeon and I decided we'd do the VSG.  I have to be on PPI forever because of my rheumatoid meds.  So there's always a pros/cons analysis with every medical intervention.  Sometimes it's worth the risk, sometimes it's not.

Also, I was watching a video from a bariatric surgeon the other day (Dr. Alvarez), and he said that most reflux pre-WLS is due to either obesity or a hiatal hernia.  He fixes the hiatal hernias at the same time as the sleeve, and he said that if the hernia is repaired and the sleeve is properly constructed, people shouldn't have reflux past the first few months.  And during that time it should be controllable with medication.  I don't know how true that is, but it does show that different surgeons see the situation differently based on their training and experience.

Absolutely, it's like the 80mg aspirin being more important to someone who's had a heart attack than the risk of ulcers in RNY.

Barretts/cancer of the oesophagus is a real threat to anyone with GERD, but if you have something else more likely to kill you, then maybe VSG and a life of PPI's is a better choice for you.

I personally would NOT have a VSG if I had suffered from GERD.  Anecdotally, VSG to RNY for this reason is an ever more preventable revision we see now.

We really do have to be jointly responsible and not ignorant or passive in these huge surgical decisions.

I will tell you from personal experience that what Dr. Alvarez said was NOT true in my case.  Is it a possibility for others?  Sure,  But not for me.  I never had reflux prior to surgery, even though I had a hiatal hernia.  My hernia was repaired during VSG, and I had a perfectly shaped sleeve (and no, I didn't take my original surgeon's word for it, it was confirmed through barium swallows and a myriad of other tests).  I developed reflux/severe GERD 8 MONTHS after my VSG.  That's right, I was reflux free for 8 months before I began to experience acid that was ultimately measured as 409% higher than average.  My GERD was NEVER controlled by medication.  The only thing that gave me any relief was Dexilant, but at almost $400 a month, it was unworkable for me and I have since revised to RNY.  I understand why you chose sleeve even with pre-existing GERD, but I have such a hard time with people who had GERD pre-surgery who either weren't advised of the risks (the surgeon's fault) or were advised and chose VSG anyway, who are now dealing with acid. 

Knowing what I know now, I would NEVER have a VSG, absent extenuating cir****tances, if I had any history of GERD.  I would never bank on it going away after surgery because the design of the sleeve itself promotes acid issues (a high pressure system which, because of the pyloric valve leaves excess acid only one way to go . . . back up through the esophagus.  The dangers, again absent extenuating cir****tances like you have, are not worth it especially when there's a perfectly good alternative in RNY.

Again, this is just my opinion based on my own experiences.  

I absolutely agree that the patient needs to be made aware of the risk.  Otherwise, IMNSHO as a nurse, the physician has failed to obtain informed consent.  My surgeon and I discussed it thoroughly and we made the decision together.  I knew there was a risk my GERD would worsen, but we needed to try it for the other reasons.  Knock on wood, so far so good.  :)

If you are taking nsaids are you familiar with a drug called Arthrotec?  It has diclofenac and misoprostol, a nsaid and a stomach protective drug. I took it pre surgery because I had problem taking nsaids for more than a day or 2 and my dr wanted me on a 2 week course. 

I'm not aware of it, but I've been on PPI for a while because of the meds I'm on for the rheumatoid disease and likely will be for a long time to come.  Because there's no blind stomach with the sleeve, I and my team are OK with the risk and we're monitoring it.

I don't take NSAIDs often, and just got my doc to switch me to a topical NSAID for my hands/wrists to reduce the amount in my system.

I just wanted to mention it because it worked amazing for me, in case you ever need another alternative to try. 

I agree, if you ever took a PPI even once in your life for acid reflux. You should not be allowed to do the the vsg. 

I rarely took tums  pre op. Didn't even realize what PPIs were until later on heh.

Who exactly does the "allowing?" Our health is our own responsibility. It's up to us to research and make proper choices.

Not to mention the OP was self-pay, which means she specifically sought to bypass the healthcare system/restrictions.