Seeking bariatric doctor advice: VSG to Gastric Bypass revision, any suggestions?

It's possible that your weight loss stalled due to a combination of factors, including the small pouch above your sleeve, the ventral hernia, and bile reflux. While your sleeve appears intact, any anatomical changes, such as the pouch in your chest cavity, could affect digestion and how food moves through your system. A ventral hernia can also contribute to discomfort, inflammation, and changes in eating habits, which may indirectly impact weight loss. Bile reflux, which is different from acid reflux, can cause irritation in the stomach and esophagus, potentially affecting digestion and nutrient absorption. If your surgeon has suggested a revision to a gastric bypass after trying medications, it may be because bile reflux is harder to control after a sleeve and a bypass could help redirect bile flow while also promoting further weight loss. Since you haven’t regained any weight, your body may have simply reached a natural plateau, but the presence of these findings could have played a role in how your body responded post-surgery.

Hello, thanks for your question and provided information. I recommend you to do a research about board certified bariatric surgeons that can help you to achieve your goals. You appear to be a good candidate for the procedure. Good luck finding your surgeon. I hope you can resolve your pouch issue. 

If you have bile and or acid reflux after a gastric sleeve and the symptoms are not being controlled with medicine, then you need to have the sleeve revised to the gastric bypass.  The gastric bypass is one of the best anti-reflux procedure.  I agree with your bariatric surgeon.  

I can't say for sure without reviewing your tests, but from what you say it sounds like the top of your sleeve has stretched out and herniated into the chest via a hiatal hernia.  Sounds crazy, but this is not uncommon.  This can be fixed by bringing the sleeve back into the abdominal cavity, fixing the hiatal hernia, and cutting off the excess stomach pouch.The ventral hernia is a separate problem and unrelated to your symptoms.

you say ventral hernia, but do you mean hiatal hernia? this and the pouch suggests thats the source of your GERD symptoms; that pouch could also represent retained fundus, where a lot of ghrelin is produced, which will affect your weight loss.  yes something needs to be done depending on your symptoms, how bad the gerd is, etc; can revise the sleeve and fix the hiatal hernia, convert to bypass and fix the hiatal hernia, and maybe other options, depending on what the full evaluation shows. you need to be comfortable with the plan, i'd encourage second, third, fourth opinions, as many as you need to answer your questions and be comfortable with the plan

To begin with, you should be very proud of your weight loss. The plateau is likely not caused from the hernia, instead from portions and food choices.  I would encouraged you to seek the care of a Registered Dietitian who may be able to make suggestions on which foods are more appropriate given that you had bariatric surgery, and that you are suffering from heartburn.  

He wishes to convert you to decrease reflux and heartburn. Your weight loss did not stop because of those findings, your weight loss plateaued at what you are eating and how much.