Heartburn Treatment after Sleeve Gastrectomy
Cherie from Houston sent us this question: Can some type of Fundoplication be done if I’ve had a Sleeve Procedure? It’s been 3 years and symptoms of my acid reflux are worse.
Recent UGI showed almost continuous episodes of spontaneous gastroesophageal reflux. Looking for options other than gastric bypass. Thank you.
Nissen fundoplication or any other type of partial fundoplication relies on the presence of gastric fundus (upper part of the stomach) to wrap around the lower esophageal sphincter. Gastric fundus is resected during sleeve gastrectomy. Therefore, by definition, a fundoplication cannot be performed after sleeve resection. A number of post-sleeve gastrectomy acid reflux cases have presented to Houston Heartburn and reflux Center over the past few years. Some of these patients had a perfectly done gastric sleeve in the presence of a large hiatal hernia that was not fixed during initial sleeve gastrectomy. Consequently, we were able to stop acid reflux by fixing the hiatal hernia only. This is only possible if the sleeve is properly resected and contoured; there is no narrowing or twisting of gastric sleeve lumen and the gastric fundus is properly resected. If the sleeve is narrowed at the incisura angularis during initial resection, hiatal hernia repair by itself is not likely to stop acid reflux and conversion to gastric bypass is indicated to stop acid reflux.
If gastric fundus is incompletely resected during initial surgery, then hiatal hernia repair with re-sleeve to properly contour the lumen are indicated to resolve heartburn and other acid reflux related symptoms. One may consider in this case, a partial fundoplication instead of gastric fundus resection if there is enough gastric fundus to wrap or if gastric fundus tissue is thin or stretched and one is concerned about staple line leak if resection is performed. We don’t have studies to corroborate such an approach and surgery outcome in terms of acid reflux control remains unknown.
Few reports in the literature describe the use of LINX device to stop acid reflux after sleeve gastrectomy. The use of LINX surgery in the case of sleeve gastrectomy is not FDA approved and has not been properly evaluated. However, the same principle applies regarding a twisted or narrowed sleeve lumen in which case LINX surgery for GERD is not likely to be effective in stopping heartburn.
My recommendation for you is to get thoroughly evaluated by a competent acid reflux specialist with knowledge in bariatric surgery prior to committing to any revision surgery. In some cases, you may be able to save your gastric sleeve and stop heartburn at the same time.