Avoiding Reflux After Bariatric Surgery
Bariatric patients are among the most knowledgeable and well-read in all medicine. When speaking to patients, it’s often surprising and refreshing to hear how much they already know about their surgery of choice. During this research, the patient usually comes across the concept of reflux after their bariatric surgical procedure (usually gastric sleeve) and wonders if it could happen to them. The short answer is that we genuinely don’t know, but there are ways to reduce the risk, and we discuss them in this article.
Am I Choosing the Best Procedure?
More procedures are available today than ever, giving patients great options, regardless of their circumstances or BMI. There are many options, from tried-and-true methods like the gastric sleeve and gastric bypass to newly approved surgeries like the mini gastric bypass and endoscopic sleeve gastroplasty. Similarly, patients with concerns about reflux have several options. Most commonly, if the patient has significant reflux already, they may wish to avoid the gastric sleeve and other surgeries that increase the pressure within the stomach.
Instead, patients may be best served by a procedure like the gastric bypass, which has proven very effective in fighting reflux. Indeed, stripping away its weight loss properties, the gastric bypass can be considered a reflux management procedure.
Fixing a Hiatal Hernia
A hiatal hernia is a defect in the opening of the diaphragm, known as the hiatus, that allows the esophagus to pass from the chest cavity into the abdomen. When enlarged, this hole allows stomach tissue to push into the chest, often resulting in reflux and related symptoms. Most obese patients have a hiatal hernia and are usually actively screened for this during their bariatric procedure. Should a hiatal hernia exist, it is typically repaired as part of the primary bariatric procedure. More minor repairs can be closed with sutures, while larger hernias may require mesh. Repairing a hiatal hernia typically reduces the likelihood of reflux by about half.
The two factors above are the most significant reasons for new or worsened reflux after a bariatric procedure, but there may be others. Ensuring that these factors are addressed is the most surefire way to keep the risk of reflux low.
Of course, all patients should also understand the risks of bariatric surgery and can choose whether the concerns outweigh the potential benefits. Fortunately, the incidence of reflux is relatively low, and there are many options for dealing with GERD, should it arise. These can include conversion from a sleeve to a gastric bypass or placing a GERD management device known as LINX.
Of course, the next step requires scheduling a consultation with a bariatric surgeon to take a deep dive into the benefits and risks of the procedure you believe is best. We encourage you to find a surgeon in our directory.