VSG vs Rny for GERD

 I am posting this for a pre-op whose surgeon has signed her up for an Rny because of her GERD. what can you tell her? she would prefer getting a VSG but is listening to the doctor. understandable, but I want to make sure she doesn't regret this later.

my theory is some of y'all would have better info than her surgeon. cos as we know, they don't know everything.

so - what about GERD and VSG?

 Actually, the RNY is recommended for severe GERD over the Sleeve. The VSG tends to worsen GERD or initiates it, due to the decreased stomach volume and limited space for the acid. I never had severe problems with GERD, but since the VSG, I have had some nasty attacks and experiences with it. Revisions to RNY are done in severe GERD cases.


Gail

 ah! well, if that's the case then it's find she get the Rny. I just want to make sure she gets all the info out there & I don't know a lot about it.

except I had terrible reflux post-op and PPIs keep it under control.  just realized I don't even know the difference between GERD and reflux....

 Hi, 
I am the one that Jackie has posted about.  I have been disappointed that my Dr. suggested RNY for all the same reasons I am sure most of you chose VSG.  I am so worried though.  I have had gastritis, esophageal inflammation and as I speak I can feel the acid.  I always feel like I have something stuck there.  I guess I should take my surgeons advice, but I just want to be most informed.  Thank you for all your help. 

Sherri

If a PPI or acid reducer can control your symptoms, you might be okay, but it is a discussion to have with your physician. I am almost two years out and still have to take a PPI. Has a hiatal hernia been ruled out?


Gail

I do have a hiatal hernia.  He will be fixing that during the surgery.  But I also have esophageal motility issues.  I had an endoscopy two years ago with severe Gastritis and also inflammation of the esophagus.  It is just obviously an issue.  :(  I spoke to him and also went to a seminar.  When I raised my hand and asked about this, the new physician at the seminar said he would suggest RNY as well.
They are not opposed to it at all.

This is a tough one. As others have mentioned, it kind of depends. First, I would say to make sure to have an upper GI to find out for sure whether you have a hiatal hernia. If you do, the surgeon will fix it during surgery and chances are very good that your acid will go away post surgery. Often acid is worse for a while and then it gets better.

I had bad acid before surgery (gastritis and esophageal inflammation also, though not Barrett's) and it got worse after the vsg. I developed a hiatal hernia about a year after surgery. I had one surgery with my surgeon, Dr. Jossart, to fix it, but it didn't work. I recently (about 4 months ago) had a 2nd surgery with Dr. Cirangle (Dr. J's former partner), and he was able to fix it using mesh as it had grown very large. So far, it seems to be working. I do get acid sometimes, though not nearly as bad as before this hernia was fixed. Hiatal hernias are very common among the obese, and sometimes they do show up after the patient is has lost weight. According to Dr. Cirangle, this is because the walls have been weakened and the fat is holding things together. Once weight is lost, the hole opens.

Anyway, when I went in for my consult with Dr. Cirangle, he mentioned that one possibility would be to convert me to RnY. I have to admit I looked at him like he'd suggested cutting off my head. Despite the GERD, I am VERY VERY happy with my VSG 5 years post surgery and have no regrets about my decision whatsoever!

Lizanne

Sherri, I had GERD issues prior to VSG, but they disappated during my pre op diet. I had some major flare ups the first month post VSG, but since I've lost weight and stopped eating high fat crap food, I have no issues at all. I still take a PPI each day, but will begin to wean off it in December and try to go without.

Knowing why you have GERD in the first place is a big factor in making the correct decision. I was pretty sure mine was all related to my eating habits and obesity. Since my GERD wasn't horrible and was getting better my doc completley supported my decision to go with VSG over RNY. He said that if my decision turned out to worsen the GERD we could, as a last resort, convert to RNY. I so desperately wanted to keep my pyloric valve I chose VSG. Best decision I could have made! 

 Sherri - glad you are here, lots of info for you to read and think about. don't hesitate to ask more questions as people really like to help.

good luck!

 Although it is true that RNY is sometimes recommended for GERD sufferers over VSG, my surgeon still recommended VSG, and I'm very glad he did...

My GERD/reflux have resolved since VSG...so it doesn't make it worse in all patients, and can improve it actually. I have stopped PPI meds.