Question of The Week: Band to Sleeve Revision

Question of The Week: Band to Sleeve Revision

Stacy wrote: “I converted a band to sleeve and have had horrible reflux I take PPIs, with minimal relief…it’s absolutely horrible. I converted because band slipped and kinked I traded one problem for another and paid for it all out of pocket. Help”

Dear Stacy,

Lap Band slippage is uncommon but when it happens, and lap band removal is needed to alleviate stomach obstruction, I don’t recommend a concomitant sleeve gastrectomy. Band slippage is invariably associated with severe inflammation and scar tissue formation around the gastro-esophageal junction. It is also associated with hiatal hernia formation and poor esophageal motility. I highly advise in such situations to remove the band and wait 3 to 6 months prior to any surgical intervention like sleeve gastrectomy and hiatal hernia repair.

Staging the conversion of Lap Band to Sleeve gastrectomy has many advantages. First, it allows the inflammation and Lap Band induced scar tissue around the Gastro-esophageal junction to resolve. Adhesions prevent proper gastric resection to create a well contoured gastric sleeve. A well contoured sleeve gastrectomy results in optimal weight loss and no acid reflux.

Second, waiting 3 to 6 months after slipped band removal allows the esophagus to recover. It gives your acid reflux specialist time to evaluate esophageal motility and the status of your anti-reflux barrier. A weak anti-reflux barrier must be addressed at the time of sleeve gastrectomy to prevent post sleeve surgery acid reflux.

PPIs in your case Stacy, have very limited efficacy. A poorly contoured gastric sleeve surgery with a large retained gastric fundus and hiatal hernia result in severe acid reflux. I recommend a comprehensive acid reflux work-up by an experienced acid reflux specialist. At Houston Heartburn and reflux Center we tailor the treatment to fit your particular situation. Such an approach results in complete acid reflux symptom resolution and high patient satisfaction rate. You don’t need to suffer; your problem can be reliably fixed.