How A Hiatal Hernia Can Affect the Gastric Sleeve
If you have researched the gastric sleeve, you will find the procedure increases the risk of new or worsened gastroesophageal reflux disease or GERD. This is one of the reasons why the gastric bypass may be the more appropriate procedure for someone with severe and uncontrolled GERD.
When we first started performing the gastric sleeve, there were a significant number of patients – somewhere around 15 to 20% – that would experience new or worsened chronic acid reflux after the procedure. Of course, back then, the fundoplication was the only viable anti-GERD surgery available. However, since the fundus of the stomach is removed from the abdomen, it cannot be performed on gastric sleeve patients. Therefore, sleeve patients with GERD issues either had to be converted to a different procedure (Duodenal Switch or Gastric Bypass) or had to manage their GERD with lifestyle changes and medication.
Today, we have made significant strides in the understanding of GERD and the gastric sleeve. We have reduced the incidence of post gastric sleeve GERD to approximately 10 to 15% by simply repairing a hiatal hernia if one is indeed present. However, this means that a small number of patients still experience occurred after a gastric sleeve.
What Options Do We Have Today?
While there was a time that we only had a fundoplication at our disposal, now we have a number of potential GERD treatments that offer long lasting relief. One of those is the LINX device which can be placed over the lower esophageal sphincter and prevent acid from refluxing back into the esophagus from the stomach. This procedure may make sense for some gastric sleeve patients that are experiencing new or worsening acid reflux.
Of course, there are occasions where even with our best efforts, we cannot control GERD and for those patients, the best option may be converting the sleeve to a gastric bypass or DS. Either of these procedures are extremely effective and can minimize or eliminate GERD.
The first step is to speak to one of our bariatric surgeons about the best procedure for you. If you are concerned about occurrence of GERD after a gastric sleeve, please speak to us to understand more about what you should expect and whether you are at risk.