I Never Had Reflux Before My Gastric Sleeve.

Erika from Houston sent us this question: “Hello, I am about to have the gastric sleeve surgery in a week. I don’t suffer from acid reflux; however, my mother had the gastric sleeve and does suffer from awful acid reflux. She had her sleeve surgery performed in Houston, but currently resides in New Braunfels, Texas. She suffers from pneumonia every so often at 44 years old and they are worried it may have been worsened by her surgery/ acid reflux issue. I am worried that my mom may end up with Pulmonary Fibrosis if she does not seek proper medical treatment to control the acid reflux. Please help!”

Dear Erika,

A poorly performed sleeve gastrectomy invariably results in acid reflux. Aggressive stomach resection results in functional gastric sleeve lumen obstruction. Functional obstruction of gastric sleeve drives acid backflow into esophagus. Acid reflux causes a hiatal hernia to gradually develop, and hiatal hernia development weakens acid reflux barrier.

The result is progressive acid reflux disease with worsening heartburn, food regurgitation, pain, cough and sore throat. Despite weight loss after sleeve gastrectomy, and resolution of obesity related morbidities, patients have poor quality of life due to severe reflux. Fortunately, several solutions are available to alleviate acid reflux after sleeve gastrectomy. Central to these treatment options is a comprehensive workup to confirm and stage GERD. Workup helps elucidate size of hiatal hernia and anatomy of gastric sleeve. At Houston Weight Loss Surgery Center and Houston Heartburn and Reflux Center most patients presenting with acid reflux after sleeve gastrectomy are treated with hiatal hernia repair. The minority of patients with severe narrowing of gastric sleeve lumen require, in addition to hiatal hernia repair, conversion of sleeve gastrectomy to gastric bypass.

Fortunately, over the past 5 years, we have witnessed a gradual decrease in the proportion of patients requiring sleeve to bypass conversion as more bariatric surgeons are aware of the consequences of narrowing gastric sleeve lumen.

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