Expert: John Pilcher, MD - 1/18/2009

Question
QUESTION: Five years ago I have a hiatal hernia repaired. I remember the surgeon telling me that my upper stomach wasn't large enough to wrap completely around the esophagus so he wrapped it as far as he could then used mesh to complete it and sewed it down. My question is will this cause complication with my upcoming gastric sleeve surgery? Shouldn’t my surgeon do an upper GI first?

ANSWER: Wanda,
It is certainly true that preceding surgery can create important changes in the way your tissues behave at the time of surgery, so you are correct that this is a potential concern.  However, one of the great things about the gastric sleeve operation is that it is adaptable to the physical circumstances that are found at the time of surgery, so that your surgery very likely can work around just about any preceding scarring.

As for your question on the Upper GI - it does not sound like a bad idea but I would defer to your surgeon about whether it is helpful or necessary.

Best of luck!
Dr JP

---------- FOLLOW-UP ----------

QUESTION: If they have problems with the takedown of the Fundoplication then they will just adapt and do it differently? Will the size of my stomach pouch be larger?

Answer
When I do a sleeve after a previous gastric wrap, my plan is to unwrap it as far as possible and remove the stomach that has been wrapped (part of the sleeve operation).  This is safe to accomplish in the vast majority of cases.  If it is not safe, then it is reasonable to take down the wrap as far as possible and then remove the stomach that is accessible - the sleeve is adaptable in this way.

Best wishes,
Dr JP