Need advice Sleeve Revision or DS or RNY revision?

[mrsmsd029]

I had VSG 8/29/14. I lost for the first 4 months and nothing since, regained over the last 2 years so my net loss is 39 pounds.
Had severe GERD pre-op, none after until about a year ago and getting worse. In April started having abdominal pain, nausea, vomiting (if I allowed it) and lower GI issues.
I have had an upper endoscopy (revealed mild antral gastritis, small hiatal hernia, mild esophagitis and Schatzki Ring which is a narrowing of the Esophagus,
my regularly scheduled colonoscopy,
2 abdominal ultrasounds - all negative
multitudes of blood test - all negative
Upper GI - negative except the dr doing the study made comment about the shape of my sleeve, however the radiologist did not say anything in the report
Nuclear Call bladder study - borderline
Gastric emptying study - results said "consistent with dumping syndrome".
8 weeks on Low FODMAP diet - no changes
There is no rhyme or reason to symptoms I can eat something one day and be fine have it another day and get sick, all the reading I have done says dumping syndrome is related to refined carbs and while I do have a treat on occasion I have no issues with it, I rarely eat sugar laden items nor do I drink anything with sugar I use organic stevia.
Waiting to hear from bariatric center regarding an esophagogastroduodenoscopy aka gastroscopy to see if there is anything wrong with the sleeve itself.
So IF there is to be a revision they would remove the gallbladder while in there to prevent future issues. Having read about DS and RNY I was thinking DS, however, I have read that it is contraindicated for patients with GERD and/or Irritable Bowels Syndrome that the RNY would be preferred - my biggest concern is vitamin/mineral deficiency.
I also have Fibromyalgia, Hypothyroid disease. Diabetes, fatty liver disease, and sleep apnea have been resolved although A1C has crept back up, 9.0 pre-op, lowest 5.5 2 years post-op to 5.8 now. Diabetes is rampant in my family!
Am I better to stay with just sleeve revision and some more weight loss or DS or RNY which could give me major loss? Thanks for any advice or shared experience.

 

[Larra]

My gut feeling, so to speak, is still that there is something amiss with the shape of your sleeve. We have another person here, I think she posts as Diana S. , who had a similar problem and after a huge fight over insurance coverage was revised to a DS by an experienced DS surgeon (Dr. Rabkin in San Francisco). He fixed her sleeve at the same time. Her GERD, which was severe, is gone now, and last I knew she was also doing great with weight loss.
Given your justified concerns about diabetes, the DS would be your best choice for this - it has a much higher rate of permanent resolution of type 2 diabetes than gastric bypass, which is second best (i.e. better than sleeve and far better than lap band), but the diabetes frequently returns after a few years with bypass, which this is much less likely than with DS. Of course, nothing is 100% with any operation, we can only go by statistics based on large numbers of patients. As far as nutritional deficiencies are concerned, this is a consideration with any operation that causes malabsorption, but if you make a lifetime commitment to taking your vitamins and minerals as needed daily, and eating plenty of protein, and follow your labs to adjust as needed, most people (again, it's never 100%) do well.
Sometimes, even with all the appropriate tests being done, a problem with a sleeve isn't sorted out until you are in the operating room. I think part of the problem is that until the last few years, there weren't so many people having sleeves done, so surgeons and radiologists and GI docs don't have a lot of experience diagnosing sleeve problems. The best recommendation I can offer is for you to consult with a DS surgeon experienced with lots of DS's and a good number of revisions to the DS. A consult doesn't commit you to anything and may provide a lot of valuable information to help you with this decision.

 

[Munchkin]

I agree with Larra.

When they sell you the sleeve they don't tell you the big truth. The sleeve is just another diet with a smaller stomach. It is restrictive only. Don't beat yourself up over this. You probably already know diets don't work. Most people need malabsorbtion to get the weight off and keep it off. The DS is the only surgery that gives you enough of a bypass to work.

 

[Diana S.]

Hello! Yes, I had the VSG 12ish years ago, and lost a good amount, but the weight crept back on most significantly during/after my pregnancy. I had acid reflux growing up, but these last few years my GERD was excruciating and unavoidable. When Dr. Rabkin fixed my sleeve as part of my DS revision, he said that some surgeons are so nervous about nicking the esophagus that they go too far the other way and create an hourglass shape that aggravates/enables GERD like nothing else. I was told that gastric bypass was my ONLY option because of my GERD, because I had a "high pressure" system and needed to convert to a "low pressure" one (the gastric bypass just dumps things out of the stomach into intestines without the pyloric valve regulating timing)... but after the DS I have NO ISSUES with GERD, reflux or heartburn (which to me are levels of severity, I don't know how accurate that is...) except some light instances that are infrequent and usually because I laid down too quickly after eating, or tried something too spicy. And as a revision, my weight loss is a little slower, but it's happening, I'm happy and healthy, and I KNOW I had the right surgery with the right surgeon. I'm in a size below my "when I get thinner" jeans, and I'm wearing a belt again. A BELT. So stoked!