Sleeve with poor motility

Question
I was all set to get the sleeve but when I went for the motility test it showed that I had poor motility in the lower part of my esophagus. The gastroenterologist said I had silent reflux, put me on medicine and wanted to repeat the test in 2 months. Unfortunately there wasn't any progress and he recommended that I not have the sleeve and proceed with the gastric bypass. I was really disappointed and decided to speak with my surgeon. He told me that I could still get the sleeve because the motility test is not used as a determining factor in which surgery I have and that there wasn't any literature to back up the fact that I would have problems with the sleeve as the gastroenterologist had said. Needless to say I am confused and need some advice.

Answer
Sabryna,
This is a tricky question, and the "final answer" is not yet in.  I have to say that the gastroenterologist has a point, for the reasons I will expand on next.

Although there is no solid literature that clearly defines the effect of the Sleeve on esophageal motility problems and on reflux, most of us who have done a lot of Sleeve operations agree that the Sleeve does not help the esophagus and does not help reflux.  In fact, in some cases it probably makes reflux a bit worse.  So, although your surgeon is technically correct, I have to say that practical experience favors the opinion of your gastroenterologist.

The rest of the story is that the gastric bypass is a great operation for a person who has reflux and some weakening of the esophagus.  You wrote that you were disappointed with the idea of the gastric bypass, and it's not useful for me to guess about why.  At least you are curious enough to keep an open mind and explore options.

In discussing further with your surgeon, you may want to make sure he is comfortable performing a gastric bypass in case that actually is the right operation for you.  If he does not have extensive experience with gastric bypass, he may not be giving you a balanced opinion.

I hope this is helpful for you,
Dr JP

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