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Roux-en-Y for Bile reflux

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Posted 4/1/2013 7:26 PM (GMT 0)
Hey guys, I had an EGD today and the surgeon told me I had quite a bit of bile in my stomach. He said that I may need a Roux-en-Y surgery to prevent bile reaching my stomach. I'm not familiar with this surgery at all and how effective it can be for bile reflux. Has anyone had it or knows anything about the surgery?

+Recently I had an impedance study that confirmed what the surgeon saw, aslo I don't respond to ppi's or any kind of acid reducer. confused Also, I had the TIF surgery performed last year

Post Edited (TheSixness) : 4/1/2013 1:56:49 PM (GMT-6)

Posted 4/1/2013 7:55 PM (GMT 0)
Anyways, I have been doing some research and I've come across links.

http://www.redorbit.com/news/health/232383/rouxeny_diversion_for_debilitating_reflux_after_esophagectomy/

http://www.mayoclinic.com/health/bile-reflux/DS00651

http://www.goodearthnaturalfoods.net/ns/DisplayMonograph.asp?Storeid=qljs5n5jsasr2lhc0g03n0et95qt2s43&Docid=condition-bilereflux

Post Edited (TheSixness) : 4/3/2013 10:45:41 AM (GMT-6)

Posted 4/1/2013 8:17 PM (GMT 0)
Wow! Glad you posted the links. Neither option seems like fun to me. I would get a second, maybe a third opinion from surgeons who have done tons of these procedures, probably at a big medical center. At least I would be getting a very complete description of the surgery. Is this the same surgeon who did the TIF?

A really good Nissen should be able to stop the bile and other stomach contents from getting into the esophagus - my opinion only. I've never had any reflux since my Nissen (Toupet variety). I don't know what would happen if bile could still get into the stomach, even if it couldn't get into the esophagus. If you have stomach contents getting into the esophagus, maybe you need a Nissen anyway.

I'd be scared of the Roux unless it was only moving the bile duct. The gastric bypass type is routinely done for weight loss. Did your surgeon explain what he proposed?
Posted 4/1/2013 11:44 PM (GMT 0)
The surgeon I am going to now is a different surgeon than the one who did my TIF. Today after my EGD, I talked briefly with my surgeon. He mentioned to me that he saw bile in my stomach. He talked about the Roux-en-Y or a possible diversion surgery to lower the amount of bile in my stomach and to increase the rate in which my stomach empties.

I originally went to him because my ent recommended me getting the nissen done over the tif. This is because I'm having 100+ weakly acidic ph events reaching my throat a night. I've done bravo capsules numerous times and each time they come up saying that I have demeester score around 2, which leads every local GI doctor that I've been to say that I'm perfectly fine by their standards. Eventually after annoying a few doctors they referred me down to UW-health.

This is where I first found out that I was refluxing quite a bit of bile. They had me do a ph impedence test. So pretty much today, I'm working with the doctors at UW-Health and a local surgeon who my ENT referred me to. The doctors at UW-health are great, but it takes months to just get a test done, then it takes another month to get the results...I have a meeting with them coming up a few weeks. I'll ask them about getting the nissen done for bile reflux or getting a diversion surgery. From what I gathered from talking with them about my reflux is that they will recommend the nissen, so it's still a toss up.

My thought about the nissen is the same. If you have trouble burping after receiving the full 360, how can you possibly continue to have reflux problems whether is acidic or not. Also, another thought is the elimination of bile would result in less reflux for myself... really don't know, Just want the surgery that's going to help me.
Posted 4/2/2013 11:16 AM (GMT 0)
Sixness,

UW-Health.....Madison, Wisconsin? If so, I would be very interested in what they do and say. I have been going to UW since 2007. I'd like to hear more about your dr visits and what they propose to do. UW will redo all testing before going forward with any surgery from what I understand.

Posted 4/2/2013 3:02 PM (GMT 0)
Yuppers! I'm currently going to Uw-health located in Madison. I have another PH-Impedance test coming up on the 5th. My Doctors wanted to see my level of acidic and non acidic contents on medication as well as off medication. I'll let you know when I follow up with my doctors after my PH test.

I did however ask them in my first meeting about what they would do for bile reflux. The doctors said that they would prevent acid or non acidic contents from coming up by blocking it off using the nissen fundoplication. In my opinion they seemed kinda gun ho to replace my TIF with a nissen wrap. It seemed as though they don't like the TIF what so ever.

Not sure what they would say about a diversion therapy. I'll make sure to ask them, I'll be talking to my doctor by phone within 2 weeks.
Posted 4/2/2013 3:34 PM (GMT 0)
Sixness,

Wow, what a small world! If you don't mind me asking, what GI doc are you seeing? I see Dr. Gaumnitz (UW), I believe he's one of thier top GI's. I'm very interested in what UW does and tells you as well as who your dr is.

I was lead to believe the fundo nissen is what UW prefers when it comes to surgery. I don't believe they are fans of tif, linx or RFA for barretts unless the barretts are really bad.

Posted 4/2/2013 6:09 PM (GMT 0)
Currently, I have been meeting with Dr Hall and Dr wald, but I have a meeting scheduled with Dr. Gaumnitz in may, so I will be seeing him soon. I believe Dr. Gaumnitz is the doctor who reads over all the PH tests, so I'll be meeting with him to review all my exams and come up with a definitive decision on what to do.
Posted 4/2/2013 6:28 PM (GMT 0)
Yes, Gaumnitz is the one who reads and interprets test results. Having said that I would assume that would make him one of the top GI's at UW. Do you get a "good feeling" that the dr's at UW are going to be able to do more for you than other dr's may have or are able too?
Posted 4/3/2013 3:05 AM (GMT 0)
Well in some since they already have done more for me than my local doctors. They actually had PH impedance tests that confirmed bile, whereas my local GI just kept giving me the bravo capsule tests and the barium swallow test. I like the way the doctors treat me at UW health, but it takes so darn long just to do anything. I feel as though I'm in good hands, just have to be patient.
Posted 4/3/2013 7:32 PM (GMT 0)
I can sympathize with having to wait for university appointments. It took me nearly 5 months to get my Nissen, and I had a giant paraesophageal hiatal hernia (GPEH) - a lot of my stomach in my chest - from a high speed wreck. I had to have top specialists do the op because it was a tough one - about 5 hours.

I had no trouble "passing" the tests though, with my LES valve completely open 24/7. It was not fun doing the impedance with my deviated septum from broken nose. Took 4 hours and 6 tries to get the tube in - and that was only by using a pediatric endoscope, putting a wire through it, and threading the little tube over that.

My BRAVO fell off after 24 hours, but fortunately my doc said a GPEH wasn't going to get better, so I didn't need that test anyway. I kept track of the readings, below 1, often 0, until it fell off. It doesn't get any worse than that.

I asked about the other types of surgery, but I wasn't a candidate with a huge hernia. They had quit trying a lot of the different things they tried because the success rate just wasn't as good as with the Nissens - high 90%s.
Posted 3/13/2015 7:15 PM (GMT 0)
can you tell me which doctor you went to that said you may benefit from diversion surgery?
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