Many patients can suffer from mild or debilitating Reflux / Heartburn / Regurgitation of acid/food in their throats after Sleeve Gastrectomy. Understanding their problem and its solutions, helps cure the reflux after sleeve gastrectomy.

GERD (Gastro Esophageal Reflux Disease) in common in overweight people. Losing weight can help improve the reflux (GERD). Patients undergoing Sleeve gastrectomy can have reflux before the surgery and in some patients the reflux may even get better after surgery due to weight loss. However, about 30% of patients may develop neo (new) heartburn/ Reflux/ GERD after sleeve gastrectomy. Overall, 60% of the patients after sleeve gastrectomy can suffer from heartburn.

The heartburn after sleeve gastrectomy may be mild or severe. Mild reflux can be managed with simple measures; however, severe reflux can be debilitating and disrupts normal lifestyle.

Controlling mild reflux / GERD after sleeve gastrectomy

Mild reflux after sleeve gastrectomy can be controlled with dietary adjustments. Taking small dry meals and drinking an hour before meals helps. One should avoid eating 3-4 hours before going to bed. Using extra pillows and propping up the head end of the bed may also help.

Use of medicines to help control GERD post Sleeve gastrectomy

Medication like PPIs (proton pump inhibitors) and antacids do help to relieve the symptoms. Medication is more effective when the conservative measures described above are also observed. These medicines can be bought over the counter.

Management of severe reflux after sleeve gastrectomy when conservative and medical management fail to control the symptoms

One should seek resolution of reflux and its symptoms as severe reflux can cause many problems:

• Severe symptoms of debilitating heartburn
• Sore throat with acid/bile taste in mouth
• Cough
• Chest infections
• Exacerbation of asthma
• Mouth sores, dental and gum problems
• Blocked nose or symptoms of sinusitis
• Damage to the esophagus (food pipe) which may lead to ulcers
• Cancer of esophagus, which, has poor outcomes

Option of surgery must be considered, if all conservative measures and medical treatments have failed to control Gastro Esophageal Reflux Disease – GERD after sleeve gastrectomy

After failure of conservative and medical treatment one must not keep suffering and cause damage to gullet, throat or lungs and should consider surgical treatment options.

Conventional and modern surgical options a post sleeve gastrectomy a patient is offered to control reflux/GERD

Traditionally, the patients in this scenario are offered a gastric bypass operation.

We believe that Amir’s Dubai Repair – ADR is the right choice of operation

Potential risks associated with Gastric Bypass operation in this situation

Gastric bypass is a major operation involving resection (cutting) and anastomoses (joining the intestines). In majority of the cases this will be safe. However, its potential risks include:

• Bleeding
• Anastomotic leakage
• Severe sepsis leading to long stay in hospital/ICU (Intensive care unit)
• Death

Success of a Gastric Bypass operation is in controlling reflux after sleeve gastrectomy

Gastric Bypass will be effective in about half the patients in the rest the reflux will continue.

It is generally hailed as an Antireflux operation by surgeons, which it is not. Failure rate to control reflux and even development of reflux after a bypass (neo reflux) is reported in literature.

Chances of failure of Gastric bypass surgery to control GERD after sleeve gastrectomy

About 40% the patients after the bypass will continue to have reflux

Further surgical options once Gastric Bypass operation fails to control reflux/GERD after sleeve gastrectomy

Generally, there have been no reasonable and effective options available to the surgeons or offered to the patients. We believe that Amir’s Dubai Repair – ADR remains the only sensible Antireflux option in this scenario.

Currently surgeons in their “desperation / face saving mode” would at times suggest and even perform completion gastrectomy and Roux en Y Oesophago Jejunostomy on rare occasions when a gastric bypass has failed to control reflux after an initial sleeve gastrectomy.

A patient should avoid having a total/completion gastrectomy and Roux en Y Oesophago Jejunostomy, if offered to control reflux after gastric bypass operation

This operation is doomed to fail to control reflux. Its risks and complications are similar to the gastric pass operation as mentioned above.

In addition, after completion gastrectomy and Roux en Y Oesophago Jejunostomy one cannot perform Amir’s Dubai repair. Thus, all chances of controlling reflux are lost.

Amir’s Dubai Repair – ADR is the safest and reliable surgical treatment for patients suffering from reflux that cannot be controlled with conservative means and medication?

In our experience Amir’s Dubai Repair – ADR has proved to be safe, effective and reliable to control reflux after sleeve gastrectomy or gastric bypass.

Amir’s Dubai Repair – ADR is not an experimental operation. It’s based on the established principles of anti-reflux surgery,

Outcomes of Amir’s Dubai Repair – ADR

Our follow up and audit has confirmed excellent results for Amir’s Dubai Repair – ADR.

The safest and reliable surgical treatment for patients suffering from reflux that cannot be controlled with conservative means and medication?

In our opinion, at present Amir’s Dubai Repair – ADR is the safest, simplest and reliable option for reflux after sleeve gastrectomy or bypass operation.

Is Amir’s Dubai Repair ADR an experimental operation?

No, Its based on the established principles of anti-reflux surgery,

Does Amir’s Dubai Repair offer good outcomes?

Yes, our follow up and audit has confirmed excellent results so far.

Is Amir’s Dubai Repair – ADR a complex operation?

Yes and No.

Yes, because a surgeon must be highly skillful in Antireflux surgery. He should also have mastery of Bariatric surgery. Long term work experience at high volume tertiary referral centers dealing with primary, re-do and complex Antireflux surgery is crucial to tackle such cases.

No, it is not a complex operation from the patient’s point of view, as its minimal invasive (keyhole/ Laparoscopic surgery) and does not involve cutting or rejoining of the intestines and stomach like a gastric bypass operation (resection and anastomoses). In the hands of an experienced surgeon the surgery should be safe and smooth.

The hospital stay is generally 1-2 nights only. Recovery is quick too.

Why Amir’s Dubai Repair – ADR is better than the current treatment option?

Amir’s Dubai Repair – ADR is better than doing gastric bypass for reflux after sleeve gastrectomy for the following reasons:

• Amir’s Dubai Repair – ADR is less invasive operation
• Risk of complications is much lower with Amir’s Dubai Repair – ADR
• Recovery is quicker with Amir’s Dubai Repair – ADR
• Time taken after surgery to return to activity, exercise and normal life is much shorter after Amir’s Dubai Repair – ADR, compared to a gastric bypass operation
• Outcomes in terms of control of reflux is greatly better after Amir’s Dubai Repair – ADR, than a gastric bypass

Hospital stay after Amir’s Dubai Repair – ADR

The hospital stay is mostly 1 night in the hospital after surgery. In some cases, if another operation is combined to correct the complications of previous sleeve gastrectomy/ Gastric Bypass or any other issues then the stay can be longer. In case of any complications from surgery, one may need to stay in longer too.

Recovery After Amir’s Dubai Repair – ADR

Patients will be mobilising on the day of surgery after recovering from the anaesthetic. They will walk the following day and will be discharged home, if everything is fine.

Light walks can be commenced within 3-5 days.

Driving can be commenced once one is pain free and moving comfortable. This is generally day 5 to day 7 after the operation

Light gym exercise and yoga can be commenced after 2 weeks

Heavy exercise should be best avoided for 6 weeks after surgery

Diet after ADR – Amir’s Dubai Repair surgery

• Patient will be commenced on liquid diet on the day of surgery with juices and soups
• Soft diet like scrambled eggs can be taking the day after surgery
• Light diet is allowed from day 3 post operatively onwards
• Generally, after two weeks a patients tend to commence eating normal diet
• It can take up to six weeks or longer to establish a “back to normal” diet
• In some patients after ADR with associated complications from previous surgery it may take longer. It is important to remember that after weight loss surgery in the first place, one has to have modified eating patterns and they are never the same as they might have been before their first operation.

Life After Amir’s Dubai Repair – ADR

Our medium-term results (up to 3 years after ADR – Amir’s Dubai Repair surgery done for previous sleeve gastrectomy or bypass) have shown excellent results and 100% satisfaction rate. Patients have reported good quality of life.

Professor Amir Nisar’s fascination for Bariatric surgery led him to organize the first Laparoscopic bypass operation conducted in the United Kingdom in Royal Surrey County hospital in 1999. He visited the best centers in Europe to learn the techniques in bariatric surgery. He worked with Professor Alberic Fiennes, the president of BOMSS (British Obesity and Metabolic Syndrome surgery).

He set up centers for bariatric teams and surgery in 5 hospitals from scratch in Kent, United Kingdom. He has managed to achieve excellent outcomes and results in his patients through thorough assessment and offering them appropriate surgical options advice. He is meticulous with surgery and follows a robust post-operative follow-up plan for the patients, crucial for good outcomes.

Management of Complications of Weight-loss Surgery

Professor Nisar’s extensive experience and interest in GORD / GERD (Gastro-Oesophageal reflux disease) have helped him to deal with the very complex scenarios after bariatric surgery:

• GORD after Sleeve Gastrectomy
• GORD post Proximal gastric bypass surgery