Self pay, deciding between DS vs SADIS due to complication concerns -

[TheRealist]

Hi all,

Thanks so much for all the comments. I had decided on doing a DS with a CC determined by Hess (if Enochs will do it) or 150cm. However, I had my GI clearance pre-op appointment and the doctor seemed to think a DS would be a bad idea because my swallow study may indicate gastroesophageal reflux.

Now, as far as I know, I've never had any reflux issues. I have no symptoms (no heartburn, no regurgitation). The only symptoms I've ever had would be belching, but that only occurs after I drink a lot of diet coke (I have a diet soda problem - which will need to be fixed before any surgery obviously). But I'm pretty sure thats due to carbonation, not reflux.

The GI doctor has scheduled an endoscopy tomorrow to get a better look. The barium swallow study showed a little bit of reflux but I didn't even know I had that. What are the options if the GI doctor recommends against a DS because of reflux concerns? Has anyone done it anyways and ended up OK? I don't want to give myself severe reflux for the rest of my life.

As an aside, the cost of healthcare is enraging. Even with insurance, I could be paying anywhere between $350 and $1,200 for this endoscopy. I don't know the actual price, no one will tell me (I tried my insurance....the facility....the doctor...). It seems like a drop in the bucket when you are paying $14,000 for surgery that insurance does not cover, but it is adding up.

 

[Larra]

First, this issue shouldn't affect a decision between DS vs SADI because both have the sleeve.
Of more importance, many people have some degree of reflux just from being MO. When you lose weight, this may (or may not) improve. Also, your surgeon can make a not too narrow sleeve. The people who really get into trouble are the ones who have the sleeve as a stand alone, and the surgeons often deliberately make a very narrow sleeve in the hopes of preventing weight regain - when surgeons first started doing VSG, they made the sleeve the same as for a DS (i.e. more roomy, like 3-4 oz) and patients either didn't lose well or, more likely, regained after 3-4 years. It's more likely that, rather than preventing regain, the narrow sleeve just postpones it, but for sure it can lead to bad reflux that can be difficult to treat.
Unless your reflux is severe, don't let anyone talk you into doing gastric bypass instead of sleeve. There are lots of good meds these days for reflux, and with a roomy sleeve and weight loss most likely you'll be fine.

 

[TheRealist]

I thought it was the curvature of the sleeve, and not necessary the size, that caused reflux issues?

It just seems unlikely to me that someone who has no symptoms of reflux is going to end up having severe reflux after getting a DS. But the GI doctor seemed to recommend strongly against it and was pushing me towards gastric bypass. I don't actually want a gastric bypass though because the research shows a not insignificant number of people regain long-term (thus wanting the DS!).

I am hoping after the endoscopy, he'll clear me for a DS, but if not I guess I'll have to see what Dr. Enochs is going to do.

 

[southernlady]

Ok, I had reflux before and I still have it. RNY is supposedly best for those with reflux but I know quite a few RNYERS who suffer from it.

You can have what is called silent reflux which doesn’t have obvious symptoms. https://www.webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux#1

 

[TheRealist]

How much did the severity of your reflux increase after a DS, southernlady?

 

[southernlady]

How much did the severity of your reflux increase after a DS, southernlady?

It decreased a bit but not enough to come off a PPI. Was on 40 mg of Prevacid pre-op, now 30 mg of the generic of Prevacid works as well.

 

[Susan in Tennessee]

I thought it was the curvature of the sleeve, and not necessary the size, that caused reflux issues?

It just seems unlikely to me that someone who has no symptoms of reflux is going to end up having severe reflux after getting a DS. But the GI doctor seemed to recommend strongly against it and was pushing me towards gastric bypass. I don't actually want a gastric bypass though because the research shows a not insignificant number of people regain long-term (thus wanting the DS!).

I am hoping after the endoscopy, he'll clear me for a DS, but if not I guess I'll have to see what Dr. Enochs is going to do.

Does the "GI guy" even know much about DS? From what we learn/hear about physicians knowledge, it's doubtful.

 

[Larra]

Yes, the moment some GI docs (and bariatric surgeons) hear the word reflux, they recommend gastric bypass. For someone with severe reflux, that may be the best option, because it does have the best results for fixing reflux. But for most people, a not too tight sleeve will work out just fine. I had reflux before my DS. I still have it. I take one 20 mg Prilosec daily and occasionally pop a Tums and that does it. And that Prilosec is extended release, so I may be absorbing less than the full 20 mg at that. This thing with reflux is almost a knee jerk reaction.
You already know that weight regain, and inadequate weight loss, is a big problem with gastric bypass. Gastric bypass also has the huge disasdvantage of making NSAIDs contraindicated for the rest of your life. You're young now, maybe you don't need them just yet, but NSAIDs are one of the most commonly prescribed drug classes, and who knows what your future holds. There is no perfect bariatric operation. If Dr. Enochs hears the word reflux and balks at the DS, you still have the option of Dr. Esquerra in Mexico. Bottom line, you are the one who will live with the results of your surgery, it's your decision.

 

[Susan in Tennessee]

Well said, Larry. It really irritates me how these surgeons act as if it's THEIR choice what surgery a patient receives! In most cases, not all I admit) its preference. Especially when it's a self pay person.

 

[Susan in Tennessee]

Well said, Larry. It really irritates me how these surgeons act as if it's THEIR choice what surgery a patient receives! In most cases, not all I admit) its preference. Especially when it's a self pay person.

sorry for changing your name to Larry! Autocorrect strikes again! Lol

 

[Spiky Bugger]

?..

What are the options if the GI doctor recommends against a DS because of reflux concerns? Has anyone done it anyways and ended up OK?
...

A better-informed/less-anxious GI doctor?

My DS surgeon did my pre-op endoscopy himself. If I had had another doctor do it, my surgeon would have needed the video to make his own decision about whether he thought my guts were "up to" the DS. He would not have gone by another doctor's report.

I have encountered GI docs who were openly hostile re bariatric surgery. The comment "I long ago ceased being surprised by what people do to their bodies," was one of the more offensive.

Btw, the Lap Band gave me reflux. We took it out and I had the DS. Reflux is still there. Much better than a BMI in the mid 50s.

 

[TheRealist]

Wanted to update this - had the endoscopy (can't wait until I get that bill) and was told that I don't have enough reflux issues to cause any concerns. From a GI perspective, I am a good candidate for the DS.

I've been looking at the medical research comparing complication rates between DS and SIPS (my original reason for considering SIPS), and it the data just seems to be all over the place. Many DS studies show low complication rates, but there are a few high outliers. Most of the SIPS studies show lower complication rates, but again my concern is avoiding weight re-gain in the long-term.

I'm nervous about complications bankrupting me but I think I am in the DS camp now after all these replies. While the complication rate does appear to be higher (in some studies), it isn't (usually) that much higher.

 

[southernlady]

Wanted to update this - had the endoscopy (can't wait until I get that bill) and was told that I don't have enough reflux issues to cause any concerns. From a GI perspective, I am a good candidate for the DS.

I've been looking at the medical research comparing complication rates between DS and SIPS (my original reason for considering SIPS), and it the data just seems to be all over the place. Many DS studies show low complication rates, but there are a few high outliers. Most of the SIPS studies show lower complication rates, but again my concern is avoiding weight re-gain in the long-term.

I'm nervous about complications bankrupting me but I think I am in the DS camp now after all these replies. While the complication rate does appear to be higher (in some studies), it isn't (usually) that much higher.

I bet if you looked at complication rates of other surgeries on morbidly obese individuals, they would also have outliers, regardless of what surgery it is. Hell, even a simple wisdom tooth extraction caused death.

 

[Larra]

The complication rate is bound to be higher when done by a surgeon with less DS experience who doesn't do it on a regular basis. But personally, I consider failure of a bariatric operation to provide sustained weight loss to be a complication. You are free to disagree.

 

[DianaCox]

Keep in mind that many of the surgeons and insurance companies still take the position that the DS should be limited to the fattest people, who are inherently the riskiest patients, and also the older and sicker patients. They skew the overall complication rate.