sleeve procedure and gerd

Question
Hi Karka, I will try to make my question short. I am 21 years old and weight 280 /5.9 tall. I have gerd (slightly everyday and 2 times a month really strong) I try to control it with omeprazole and aciphex. They work kinda ok unless I have a gerd attack (no way to stop it for 3 hours) . Do you think I can be a candidate for the sleeve procedure since it is less invasive? thank you so much for your advice. Rosy

Answer
Hi Rosy:

Well, your BMI definitely qualifies you for bariatric surgery.  As for your GERD, there's no way to tell how your Sleeve would affect it.  For some people, their GERD actually improves--whereas for others, the Sleeve causes GERD.  There was actually a description of a new procedure that you might find interesting--basically it was a standard, narrow sleeve with a Nissen wrap. It was successful--but it was only done in three patients.

I would take the article to your gastroenterologist and to any bariaric surgeon you consult and see what they think.  There's a chance that you could end up with good weight loss and resolving your GERD--which would be fabulous.  But there's also a chance, you could end up with weight loss yet worse GERD.   

Obes Surg. 2007 Jun;17(6):820-4.
Antireflux sleeve gastroplasty: description of a novel technique.

Fedenko V, Evdoshenko V.

Bariatric Practice, Federal Medical Center, Moscow, Russia. [email protected]

Erratum in:

   * Obes Surg. 2007 Jul;17(7):996.

BACKGROUND: Laparoscopic sleeve gastrectomy for morbid obesity is associated with a high incidence of postoperative permanent heartburn as a result of gastroesophageal reflux. In order to avoid this complication, the authors developed a new technique, combining the creation of a very long and narrow vertical gastroplasty with an antireflux procedure. METHOD: The new operation was performed in 3 patients with BMI 40, 46 and 50 (1 male, 2 females). All the procedures were conducted laparoscopically using 6 trocars. The greater curvature of the stomach was mobilized in the antral region. A primary hole in both walls of the stomach was made in the antrum 5-7 cm proximal to the pylorus. Starting from this hole, the stomach was stapled and divided along a 33-Fr bougie to the angle of His, creating a long (15-20 cm), narrow tube. The divided fundus was then passed behind the mobilized abdominal part of the esophagus and a 360 degrees wrap was made (as in a Nissen procedure). RESULTS: None of the 3 patients developed complications. Excess BMI loss at 5 to 7 months has been good. No signs of esophagitis have been revealed during postoperative upper GI endoscopy. CONCLUSION: This operation is technically simple. Preliminary early postoperative results regarding its antireflux and weight-loss effects are encouraging.

PMID: 17879584 [PubMed - indexed for MEDLINE]

Hope this helps!

Kind Regards,
Karla

1. Prev:Gastric Sleeve after Lap Band
2. Next:lap band consideration