Could a resleeve be the answer and jump start my weight loss again?

Question

Had VSG in 2013. Starting weight 215. Lowest 175. Currently. No reflux prior to surgery. I now have GERD, bile reflux, 3 cm hiatal hernia, gastritis, and esophagitis, retained fundus, and dilation of body and pouch. Since I had no reflux prior to VSG, and given that recent endoscopy revealed known causes of reflux -- retained fundus, dialated pouch, and hiatal hernia --could a resleeve be the answer and jump start my weight loss again? Would rather not go the RNY route. My reflux is controlled on PPI.

Babak Moeinolmolki, MD, FACS · Answer

Hello,
Thank you for your question. I am sorry to hear the surgery has failed to fully treat your obesity. This can be due to the initial sleeve being too large, and/or stretching over time. 
Surgical options for you now include a re-sleeve, gastric bypass, or duodenal switch. Consultation with a bariatric surgeon will help you determine the best treatment based on your experience with the first surgery, your anatomy (assessed by radiographic imaging), your other health conditions, and your health goals.
Please do not give up and know that many patients, regardless of their experience with their initial surgery, find long term results with the second surgery.
Best wishes,
Dr. Moein

Ali Solmaz, MD · Answer

A resleeve (revision of your VSG) might not be the best solution for your situation. Given that you now have GERD, bile reflux, a hiatal hernia, and dilation of the pouch, simply making the sleeve smaller again could worsen reflux symptoms, even if it helps with weight loss. Your retained fundus and dilated pouch contribute to both weight regain and reflux, but the hiatal hernia is a major factor in GERD as well. While a hiatal hernia repair could help reduce reflux symptoms, a resleeve does not address bile reflux, and it could increase pressure in the stomach, worsening GERD over time.
One option to consider is a hiatal hernia repair alone. If your primary concern is reflux and not significant weight loss, fixing the hernia might be enough to improve your symptoms. Another option could be a resleeve combined with hernia repair, which might help with weight loss but could still worsen reflux, especially bile reflux, over time. Roux-en-Y gastric bypass (RNYGB) is known to be highly effective in resolving GERD and bile reflux while also supporting weight loss. However, I understand that you're not keen on going this route.
Since your reflux is currently controlled on PPIs, and if you're set against RNY, you could consider a hiatal hernia repair with a possible resleeve, but it would be important to discuss the risks of persistent or worsening reflux with a bariatric surgeon.

Ariel Ortiz, MD, FACS · Answer

Hi there, I’m sorry to hear you are struggling with GERD, as you know a hiatal hernia is the most common cause of persistent heartburn, and a hernia repair can be done simultaneously with another bariatric surgery. I suggest you having a consult with a certified Bariatric Surgeon, so we can recommend the surgery that best suits your needs, like a Re-sleeve, a Gastric Plication, or a Gastric Bypass, since there are certain surgical techniques that can help you more than others. I hope you can find the results you are looking for.- AL

Pablo Garcia, MD · Answer

Hello,
I would definitely consider the case for an evaluation, reading the information you have provided the gastric revision can be taken in consideration. The first thing is that you must evaluate yourself with a certified bariatric surgeon who can perform the Switch, also review your case and then proceed to take the best decision for you. Do not get discouraged in the search of options to improve your health.
My Best Regards

Could a resleeve be the answer and jump start my weight loss again?

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Could a resleeve be the answer and jump start my weight loss again?

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