GERD Reflux after Sleeve Gastrectomy: Effective solution with Conversion to Gastric Bypass
The estimated number of Gastric Sleeve or Sleeve Gastrectomies performed annually in the USA is about 150,000. This effective bariatric procedure is among the least invasive physiologically since it is not associated with malabsorptive component. However, this procedure might not be perfect for everybody. One of the most frequent side effects is reflux of gastric contents into the esophagus associated with heartburn, regurgitation with sour tasting fluid coming up, chronic cough, throat burning or lumpy sensation in the chest or throat.
If conservative measures like acid reducing medications, avoidance of deep fried foods, acidic juices, soft drinks, certain fruits and caffeine do not work, patients should consider surgical treatment – Sleeve conversion to Gastric Bypass frequently with Hiatal hernia repair.
There are number of potential causes for development of significant GERD after a Sleeve surgery:
- Performing primary Sleeve Gastrectomy on patients with significant GERD, large Hiatal hernia, bile reflux
- Sleeve herniation into the chest later on after surgery with development of large Hiatal hernia
- Abnormal movement of the esophagus, a dysmotility that is exacerbated after surgery
- Incompetent valve mechanism of the esophago-gastric junction
- Sleeve stricture or narrowing by the scar tissue with angulation or twisting of the Sleeve
- So called “retained fundus” or excessive portion of stomach in the proximal part of Sleeve gastric tube
- Bile reflux
- Pressure gradient between narrowed stomach and esophagus with incompetent valve mechanism
All three surgeons were named
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Highest Ranking by Patients in Maryland
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All major insurances accepted
Most major commercial plans are accepted
Rated as Top Docs in 2022 by referring physicians
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With proper education with a dietician and regular follow up, Sleeve conversion to Gastric Bypass is associated with additional weight loss and improved quality of life. When deciding to have this operation, we encourage you to evaluate how severe your reflux symptoms are, effectiveness of medication and how much these issues are impacting your life.
Another consideration is that if patients develop GERD complications like esophageal ulcers or erosive esophagitis, strictures or Barret’s esophagus (that can increase the risk of esophageal cancer) surgery might be the only answer.
There is a misconception that Gastric Bypass surgery is automatically too complicated. Obviously, when considering Sleeve conversion to Gastric Bypass, you would like to consult surgeons who are performing this procedure frequently, possess substantial experience and have demonstrated good outcomes. You would like to look for such surgery to be performed at the fully credentialed bariatric surgery center to ensure best outcomes.
At the Ascension Saint Agnes Hospital, Certified Comprehensive Bariatric Surgery Program (accredited by MBSAQIP program of the ACS/ASMBS), our multidisciplinary team takes surgical, medical, dietary and behavioral factors into account to create an individualized plan of care for each patient aiming for the best possible results.
Bottomline: If you have severe, disabling GERD after Sleeve Gastrectomy with or without weight regain with proper workup and preparation conversion to Gastric Bypass with/without Hiatal hernia repair is the best and safe treatment option.