Acid reflux and Swallowing disorders
Heartburn and acid or bile reflux can be serious symptoms especially if they are frequent and particularly if they are associated with coughing and choking at night. These symptoms usually indicate a weakness in the valve between the esophagus and the stomach and can affect anyone irrespective of weight. Such weakness can be made worse by a small hiatal hernia or a large paraesophageal hernia. After weight loss surgery, it could also result from herniation of a prior sleeve gastrectomy into the chest (a hiatal herniation of the sleeve) or from a slipped lap band.
Effective treatment is determined after a number of tests have helped to localize the cause of the problem. Briefly, the treatment options consist of the following:
Repair of hiatal hernia with Nissen wrap
This is a surgical option that is appropriate when reflux occurs in a person of normal weight. It consists of repairing the hiatal hernia and then using the upper stomach to create a wrap (like a blanket) around the lower esophagus. This procedure can result in complete resolution of reflux symptoms, abolish the need for reflux medications and potentially reverse some of the acid or bile induced damage to the esophagus.
It is not an ideal procedure in patients with severe obesity because the excessive weight can cause the repair to fail making a future repair risky because of scarring. In such patients, a gastric bypass is considered a preferred option.
Roux-en-Y gastric bypass
The Roux-en-Y gastric bypass is an exceptionally good and durable operation for the treatment of acid reflux in a person with severe obesity. Not only does it eradicate reflux, but also helps with weight loss and resolution of medical conditions that invariably accompany obesity.
Counseling on postoperative dietary changes and the need for mineral and multivitamin supplementation are essential parts of preparing for a Roux-en-Y gastric bypass.
Repair of hiatal herniation of sleeve gastrectomy
Among the bariatric procedures, sleeve gastrectomy is the most prone to developing acid reflux and is often associated with hiatal herniation of the upper portion of the sleeve.
Simply reducing and repairing the hiatal hernia is often not adequate for durable treatment of the reflux. In most circumstances, conversion to a Roux-en-Y gastric bypass would provide lasting resolution of the acid reflux.