Vertical Sleeve post Nissen

Question
I had open Nissen done about 15 years ago.  I spoke to WLS surgeon who has advised me that he could do the Vertical Sleeve surgery but he wants to leave the Nissen in place to avoid potential reflux problems I had previously.  Can this still result in the expected weight loss of a normal Sleeve surgery or is there something I should be concerned about?  Thanks.

Answer
Mr. Broussard,
You are asking a very insightful and important question.  There is no consensus in the surgical community about the right approach for a patient who has had prior Nissen surgery.  The fact of the matter is that whatever is done, your history of reflux and Nissen *may* interfere with optimal results in terms of weight loss and swallowing function.

Some surgeons would try to "take down" or undo the Nissen as part of the bariatric procedure.  This might give better weight loss but may be risky (possible injury to esophagus as well as stomach), and may allow more reflux as your surgeon has indicated.  The majority of surgeons would probably leave the Nissen wrap alone and work with it in place as well as possible.

At least you know there is no wrong answer!

Best wishes,
Dr JP

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