Andrea from Houston sent us this question: “I had a gastric sleeve surgery roughly 8 years ago.  My heartburn is getting worse and worse. I require several tums to make it through the night. Heartburn is worse at night when lying down. I also have cough and taste acid in my mouth. I would like to convert the sleeve to possible bypass. Thank you”.

Dear Andrea,

Heartburn treatment after sleeve gastrectomy is not always a sleeve to gastric bypass conversion. Gastric sleeve to bypass conversion is only needed in cases of sleeve lumen narrowing. A poorly performed gastric sleeve may be associated with twisting or narrowing of lumen leading to backflow of bile and acid into esophagus. Nowadays, we rarely encounter this complication. The most common cause of heartburn following sleeve gastrectomy is the presence of a hiatal hernia.

A hiatal hernia is an enlarged opening in the diaphragm or breathing muscle through which gastric sleeve herniates into chest. A hiatal hernia weakens the anti-reflux barrier resulting in acid reflux. Hiatal hernia repair restores the anti-reflux barrier, and it is associated with more than 95% success rate. The procedure is outpatient. Surgery is performed through tiny incisions, and it is associated with minimal pain and fast recovery.

If you suffer from heartburn after sleeve gastrectomy do not hesitate to contact us. Gastric sleeve to bypass conversion is not needed all the time.

Other symptoms of acid reflux following sleeve gastrectomy include food regurgitation, cough, and sore throat especially at night when laying down as you mentioned in your question. Furthermore, Bile reflux, in addition to acid reflux, is quite common following sleeve gastrectomy. For this reason, proton pump inhibitors and other acid suppressors have limited efficacy in controlling GERD symptoms following gastric sleeve surgery.