VSG vs Rny for GERD

 good info.

I sent her a link to this thread & I hope she posts.

I have GERD now that I didn't have before.  I did have a hiatal hernia fixed during my surgery but I didn't suffer from GERD pre-op.  It's something that 1 Prevacid a day can take care of.  But I do wish I didn't have to take it at all.  I still would nor have an RNY over a VSG.  This has been my only "side effect".

Laura

I have problems with excess acid production (that my doc has labeled as GERD) but I dont necessarily have actual "reflux" that often. GERD (gastro-esophogeal reflux disease - basically the medical term for acid reflux) is a potential side effect from the VSG and my surgeon told me he doesn't recommend the VSG if people have more than mild reflux pre-op because it does tend to get worse if you already have it (but not always).

Personally, my surgeon has offered to revise my sleeve to a RNY and i've politely declined. I will have to be suffering major consequences from my acid before id consider it at this point. But, if the person already has some significant effects (like esophogeal erosion/irritation) from pre-op GERD, I'd be careful proceeding with the VSG.  Id be curious to know from a medical perspective if making the sleeve slightly larger might reduce or prevent GERD...maybe something worth inquiring about?  (id rather have a larger sleeve than a RNY - anyday - i just dont know if it would make a difference).

Dr. Cirangle has talked about this a great deal.  I believe it comes down to the reasons you have GERD in the first place.  He told me that sometimes VSG can make the GERD worse, but there are other times when it can actually make it better and other times when there is not going to be any difference.  I guess you would need to make sure you trust your doctor when making this decision.

Studies have shown that late-onset GERD(3-6 years post op) is closely related with both poor eating habits and weight-regain with VSG patients. The question has been raised as to whether the GERD is a result of the poor eating habits or GERD leads to poor eating habits (i.e., unconciously eating to supress acid, that feeling of 'hunger' that resolves for many with a PPI).

Conversion of sleeve to RNY is considered the definitive 'cure' for post-op GERD.

I went through the same thing, and it was a challenging decision.  I was consulting with two potential surgeons pre-op, and I'd been on a PPI for GERD for about 2 years at that point.  The esophageal scope found a fairly substantial hiatal hernia.  The one surgeon still strongly advised RNY, as he's had several patients with extremely bad GERD post-sleeve.  One gets regular botox injections into the pyloric valve, which obviously isn't a satisfactory long-term solution.    The other surgeon left it up to me, feeling the hernia was likely the cause of my GERD, so it would be resolved post-op.  I went with the second surgeon (for other reasons), and the sleeve.
One year post-op I'm still on a PPI, and recently I've been experiencing occasional break-thru heartburn, but so far no regrets.  Still, I'd like to get off the PPI because it really increases your risk of osteoperosis long-term.  I took a risk there, and it worked out for me, but it is a risk.
So, I'd say the most important thing is to see if she has a hiatal hernia or a physical cause for GERD that can be alleviated.  After that, you have to weigh the pros and cons.  Honestly, I would have done either surgery rather than stay obese.

Hi Did your Dr. do any specific tests?  Mine did a UGI (swallowing barium and looking on xray)
I haven't had much of the "heartburn issue" however, since I had my colonoscopy I seem to have heartburn.  Then in afterthought was that maybe this is what it has been all along and that is why I am hungry? 

I had GERD before and have had two of the tests where they send a camera down your throat (Endoscope) before surgery. I have been on protonix on and off for years. Dr Jossart found a hernia and repaired it that I didn't know I had while doing my VSG. Post surgery I took a bit more of the protonix on and off and now it has been probably over a year since I have had any GERD issues. I am very grateful for my VSG. Do you have a gastroenterologist and if so what did they reccomend?

I had GERD before surgery and worse after.  It is usally well controlled with 2 Nexium.

I had GERD pre-op but it was caused by a hiatal hernia. With the hernia repair, my GERD went from being uncontrollable even taking a daily PPI to being controlled via a PPI to eventually getting off the PPI (at about month 20 post-op).

I think statistically, more people end up with their GERD worse after VSG than with RNY. But some people get GERD after RnY too! (It's a small number but it happens.)

So it's kind of a crap-shoot if you go by the data... it's one of those things where it varies by individual and you have to trust your surgeon that he's diagnosed your individual condition accurately.

I can tell you if I went to a surgeon who did mostly bypass and few sleeves and he told me I should get RnY, I'd take it less seriously than if I went to a surgeon who loved the sleeve and did more of that operation than any other and was told I should get RnY. In the first case, I'd definitely get a second opinion.