I have sleep apnea, even at goal. Surgeon will not treat you untreated - PERIOD. And if they do, find another surgeon. This is serious business. Why are you guessing what will work. Do the sleep study, you'll be surprised how great life can be if it works. Read a little about the condition and the impacts on the body. You won't sleep without it afterwards. Let's put it this way - With Sleep Apnea, my skin surgeon would not have done the surgery unless I agreed to spend the night in the hospital so I could be monitored. I told him I was near borderline, so I didn't want to do it. He told me to find another surgeon, unless I agreed to stay. That's how serious a good doctor is about this stuff.

What do your endoscopy(s) show, and that possibly along with and upper GI imaging, will lead towards the answer. Yes, an RNY revision is often done to correct intransigent GERD, though it isn't the only solution - that depends on the specific cause and the skill and knowledge of the surgeon. Some docs will diagnose you virtually over the phone (you have a VSG, heartburn, therefore you need an RNY revision...) while others will look at your EDG and upper GI, curse under their breath - twenty years of doing RNYs and they think that they know how to do a sleeve... - then they will explain the problem and the possible solutions. It might be an RNY, or it might be a re-sleeve to correct some shaping issues, or maybe a Nissen (yes, it can be done on a VSG, though not all surgeons can to do it) or other method to correct a hiatal hernia.

When it comes to revisions, they are inherently more complex than a virgin WLS - both in cause and in solution - which puts a premium on finding the right surgeon for the job. Second and third opinions are essential. As with any profession, within the qualified ranks, there are the majority who are functionally competent practitioners who do the everyday jobs well (the 'B' students), the artists and gifted practitiioners who seem to do everything well (the 'A' students) and then those who scraped by with a 'C'. Look through the surgeons' CVs on this site or others, and they all do revisions because they have converted lapbands to VSGs or RNYs, but you need someone a cut above that, and that is the hard part. One proxy for the appropriate skill is to look for a surgeon who has been doing the duodenal switch for some time. As the DS is based upon the sleeve, they tend to have longer and deeper experience in dealing with them, and as it is a fairly complex procedure, that tends to weed out the 'C' and most of the 'B' surgeons.

As to excessive weight loss, you probably will lose a bit too much at first, as it is difficult to "only lose" 20 lb with these procedures. However, deviating from classic WLS rules and diets can help - drinking calories is a good thing when you are trying to avoid losing weight. Likewise common advice in this cir****tance is to go with a high fat, low carbohydrate diet (a la keto or paleo) as the high caloric density of the fats helps keep the calories up, and the low carb helps to avoid classic RNY problems like dumping and reactive hypoglycemia. Also, if going the RNY route, consider carefully the temptation to minimize malabsorption weight loss via shorter limb lengths, as that can promote bile reflux in exchange (always those compromises!)

This is why, as a general statement, it is good to keep in touch with our surgeons over the years - annual labs and follow ups if that is their preference (some practices seriously encourage that, others don't). Even though we may be doing fine for several years post-op, occasionally these questions crop up and they are often the best source of info. Our PCP will probably not know how our WLS impacts the question at hand, but often they can call in to your surgeon and get an answer so that both they and we are informed - and the surgeon usually welcomes su*****uiries (strokes his ego to be consulted!) and prevents us from doing something silly based on internet rumors (I saw it on the internet, so it must be true!) Even notionally authoritative sources such as ASMBS usually give only general guidance, and is often 5-10 years behind current clinical practices by virtue of lag in publication of posted guidance and their references.

It's great that you reached out to your surgeon; you have an unusual question, so there really aren't any great answers here. With the mention of NSAIDs, that always brings up a manic discussion, but it is usually focused around pain relief (with the usual stock answer being to OD on Tylenol) which doesn't apply to your problem. Discussing your particular problem (not just your solution of taking Pepto Bismol) with the doctor(s) should yield a better answer as to how appropriate that is, or if there is something better for your needs.

Good Morning!

If you have any doubts about the Gastric Sleeve Surgery, we're doing a new section of frequently asked questions

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Regards

Dr. Alvarez

Prior to having the sleeve I had the lap band. I had to have the lap band removed because of gerd and not keeping anything down. I am now having the sleeve converted to RNY due to Gerd. My current surgeon said that the surgeon that did the sleeve should not have even considered me for sleeve due to my history with the lap band. I lost approximately 100 lbs 12 years ago and I've kept it off, but for the last 2 years gerd has been horrible. Everything I eat comes back up. My surgeon told my insurance company that I needed to convert to RNY to sustain life. I will say that I've had a lot of stress in my life for the last 3-4 years and I don't know if that contributed to the throwing up. I also had a large para-esophageal hernia that I had repaired last year, but it hasn't helped the gerd at all. I would do my research and do what's best for you. Get a second opinion.