Wendy from North Houston sent us this question: “I am suffering severe acid reflux after Nissen fundoplication done in March. My surgeon has stretched it once since surgery when I was having severe pain upon swallowing. I am obese as well and wanted to see if gastric sleeve would offer me more relief. Is it possible to do a gastric sleeve following the Nissen fundoplication?”
Heartburn, and pain or difficulty swallowing after Nissen fundoplication are indicators of poorly performed surgery. Properly performed Nissen fundoplication is associated with immediate and complete resolution of heartburn. Properly performed Nissen fundoplication is associated with extremely low rates of swallowing issues. Indeed, our rate of postoperative dysphagia at Houston heartburn and Reflux Center is almost zero.
Consequently, you may need revision surgery for acid reflux. In the setting of obesity, weight loss surgery may be preferred over Nissen fundoplication as it allows for both weight loss and acid reflux control.
Can a sleeve gastrectomy be done after Nissen fundoplication? The answer is yes. Sleeve gastrectomy when properly performed in association with hiatal hernia repair is an effective anti-reflux procedure. Poorly performed gastric sleeve surgery that narrows the incisura angularis results in severe post-operative acid reflux.
Proper surgical technique, experience, and sound knowledge of acid reflux and obesity pathophysiology affect surgery outcome. Pre-operative patient work-up and selection are equally important.