Heartburn After Sleeve Gastrectomy

If you live in Houston, and you are considering sleeve gastrectomy for weight loss, read this first.

A properly performed sleeve gastrectomy does not result in acid reflux. Indeed, a properly performed sleeve gastrectomy along with hiatal hernia repair results in acid reflux resolution. Surgical technique and understanding of sleeve gastrectomy mechanism of action as well as GERD pathophysiology are keys to achieve successful outcome. Aggressive stomach resection over tight caliber bougie does not result in better weight loss. Rather it mutilates stomach function leading to severe acid reflux after sleeve gastrectomy. Therefore, we advocate preserving most of the gastric antrum, avoid narrowing sleeve lumen, and completely resecting gastric fundus along with hiatal hernia repair to maximize weight loss and minimize heartburn development.

If you have undergone sleeve gastrectomy and currently suffer from heartburn, you have several options to treat your acid reflux problem. First, if a hiatal hernia is present, it must be repaired. If sleeve lumen is not arrowed and gastric fundus is not redundant, your chances at acid reflux control and heartburn elimination are quite high. If sleeve lumen is narrowed, hiatal hernia repair by itself is not enough and sleeve gastrectomy to gastric bypass conversion is recommended to control heartburn.

Patients who develop acid reflux several years after sleeve gastrectomy have a slightly different pathophysiology. At the time of sleeve gastrectomy, these patients most likely did not have a hiatal hernia. They underwent a sleeve gastrectomy with functional obstruction at the incisura angularis. Over time, functional obstruction leads to acid reflux which in terms results in hiatal hernia development also called gastric sleeve migration into chest. Hiatal hernia development worsens acid reflux which in turn causes the hiatal hernia to grow. Patients are typically started on PPIs but symptoms are partially controlled. By the time patients present to Houston Weight Loss Surgery Center, they have already reached stage 3 or 4 GERD. Most patients at this stage have a widened incisura angularis and conversion to gastric bypass is unnecessary to control acid reflux. Hiatal hernia repair by itself is sufficient to control heartburn unless there is significant esophageal dysmotility.

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