Revision options after sleeve gastrectomy – RYGB (Part 3 of 3)
Conversion to Roux-en-Y gastric bypass is heavily recommended if the patient has persistent reflux from their sleeve gastrectomy. The Roux-en-Y has been extensively studied and results show that it is the gold standard in terms of controlling reflux symptoms. In creating a small gastric pouch, the acid-producing cells of the stomach are excluded, and therefore, acid reflux is drastically reduced. In addition, hiatal hernias involving the sleeve stomach can lead to reflux. A hiatal hernia is when a portion of the sleeve stomach herniates through an enlarged opening in the diaphragm, the muscle that helps you breathe and separates the chest from the abdominal cavity. In a hiatal hernia, the sleeve stomach actually sits in the chest, and because of its abnormal location, predisposes patients to acid reflux. If you have a hiatal hernia, the hernia will also be fixed during the conversion of a sleeve to Roux-en-Y gastric bypass. Fixing the hiatal hernia contributes to the excellent reflux resolution seen after a Roux-En-Y.
Another consideration to convert a sleeve to a Roux-en-Y gastric bypass is insurance coverage. The SADI-S is not covered by all insurance companies. In contrast, the Roux-en-Y gastric bypass is covered by all insurance plans that offer bariatric benefits. Therefore, based on insurance coverage, a conversion to a Roux-en-Y gastric bypass may be the best choice.
With a conversion of a sleeve to a Roux-en-Y gastric bypass, the average excess weight loss is 40-60%, which oftentimes means weight loss of 100 pounds or more. After surgery, important considerations for patients with a Roux-en-Y gastric bypass include avoiding NSAIDs and not smoking. Examples of NSAIDs, or non-steroidal anti-inflammatory drugs, include Motrin, Aleve, Advil, aspirin, Ibuprofen, and Naproxen. Discuss with your surgeon if you are considering a conversion to a Roux-en-Y gastric bypass and require any of these medications.