Continuous Belching After Gastric Sleeve Surgery

Question Below Submitted By:  

Karen C. (a patient from Port Macquarie, New South Wales, Australia)

I am a 62 year old female medical practitioner.
I had a gastric sleeve in Sydney, Australia in 2011.

I have lost 31 kg (about 70lbs). BMI has decreased from 35 to 22.

I have been distressed by belching after food or drink, ever since, despite never belching before in my life. A busy life that frequently included gulping my food.

In the last 2 years the trapped air gives me moderately severe chest/epigastric pain, which restricts my eating considerably, until belched up which sometimes can go on for 3/4 hour.
I had a 2-3 sliding hiatus hernia repair at the time, which needed to be re-repaired a year later.

Oesophageal manometry studies this year with an expert were reported as normal.

A 3D ‘fizzy’ CT scan this year showed a 60 degree kink (“corkscrew”), in my 200ml volume sleeve.

I have had 5 achalasia balloon dilatations of the incisura by bariatric surgeon No2, then pylorus dilatation, twice, by a professor, the second of which early this year gave me a “micro” perforation and “minor” peritonitis.

Bariatric surgeon No 4 did a side-to-side anastomosis in April 2015. That was later dilated to 3 cm a couple of months ago by a gastroenterology professor, who last week inserted a Megastent into the sleeve.

Whether the kink has been straightened by the stent, I don’t know. It stays in for another 10 days.

Distressingly, I have been still belching (for 4 hours after the surgery!), less as time goes on, but I’m hardly eating due to moderate discomfort and slight nausea.

Can anyone help me please?

Is the problem that that dilating the sleeve won’t help because it, at end of the day, remains mechanically kinked ?

Or is the sleeve still a high-pressure area?

Or, is there another reason for belching?

I have begun to despair, and am becoming suspicious that my (male) medical colleagues are not ‘fixing’ me, but protecting their little mate, surgeon No 1.

Perhaps a mistake has to be acknowledged before anything can be fixed.

Dr Karen C
MBBS

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01.

Expert Responses to the Question Above

Surgeon response to "Continuous Belching After Gastric Sleeve Surgery"

by: John Rabkin, MD

Dear Dr. Karen,

I would recommend continuing with your current approach and providers to assess and assist you with your post vertical sleeve gastrectomy bariatric surgery symptoms.

It doesn't seem to me that your surgical colleagues are 'covering' for one another for any 'mistakes' made: a rotation ("cork screwing") in the construction of the vertical sleeve is a well recognized adverse configuration which can cause symptoms in some patients.

It appears to me that you've undergone the proper evaluation and intervention sequence to date. I would allow some additional time to assess whether or not the recently placed stent will address your symptoms.

You may also want to consider botox injection of the pylorus, particularly if you experienced any relief from your symptoms even briefly after the pyloric balloon dilitations. If this approach helps, a subsequent operative pyloroplasty may be of benefit although this may put you at risk for 'dumping' symptoms afterwards.

Anatomically, I would be interested in knowing how the "side to side" revision was done as it appears from your description to have failed. If there is a reasonable possibility that an additional similar revision would be beneficial, that may be your next step if your current stent and potential botox injection of the pylorus is not effective.

John Rabkin, M.D.
Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Page:
- Gastric Sleeve Complicatoins

02.

Patient Responses to the Question Above

Belching after LSG

by: Prof Tarkan Karakan

Hi, I am a gastroenterologist in Ankara, Turkey. One of my surgeon colleagues referred a similar patient today. He had an LSG 3 months ago and he has a continuous belching started one month ago. He tried anti-depressants, anti-acids with no benefit.

I searched the literature and found a recent study on belching after LSG. They found that belching is mainly gastric rather than supragastric (which means reflux might be a key factor rather than air swallowing). However, no definitive treatment is available at the moment.

I have some suggestions: First speech therapist might help although the mechanism is not directly related to air swallowing. Behavioural therapy should also be considered.

Gaviscon might be better than proton pump inhibitors?

I will share my results with you after these treatment attempts.

Burping

by: Sheryl

I am so tired of burping. It starts from the time i wake until i go to sleep. Every three seconds. If i don't burp while I eat, I have to stop and pause or it will come back up. I also have lots of chest pain and my stomach feels acidic.

Same symptoms

by: Nancy

I am starting to try enzymes to relieve the same symptoms.

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