OpenHealth Q&A

Considering Options: Diversion Surgery or Anti-Reflux Surgery?

A brief background: Approximately two and a half years ago, at age 33, I began experiencing troubling symptoms including ongoing nausea, dry heaving, discomfort in the upper abdomen (specifically beneath my rib cage, occasionally radiating to my left side), intense reflux or heartburn, along with excessive burping. The intensity of my symptoms varied, fluctuating between none at all to severe enough to necessitate hospitalization. Typically, my condition worsened around half an hour after meals, and I endured 1-2 severe flare-ups monthly, during which I would be so nauseated and dry heaving that I couldn’t consume food or drink for several days, ranging from one to five. An endoscopic examination revealed I was suffering from mild chronic inactive gastritis. Various medications were prescribed, yet only Sucralfate proved to be effective. After undergoing multiple tests with negative outcomes, a HIDA scan finally confirmed an ejection fraction of 95%, leading to a diagnosis of biliary hyperkinesia. The medical team concluded that this biliary hyperkinesia likely resulted in gastroduodenal reflux, which subsequently caused my gastritis. On June 20, 2025, I underwent laparoscopic gallbladder removal. The procedure initially appeared successful; however, upon waking up, I encountered issues with low blood pressure and heart rate, requiring extended observation. Sadly, two days later, I developed a bile leak, necessitating an emergency revision surgery and the placement of a drain to rectify the problem. The following day, I had another HIDA scan to confirm the absence of additional bile leaks or active bleeding. Thankfully, the results were reassuring, except for observing some gastroduodenal reflux at the beginning of the scan that improved as it progressed. My gallbladder was sent for analysis, revealing no stones but a diagnosis of mild chronic cholecystitis. Due to the second surgery, I spent a week in the hospital. Overall, recovery has been promising; my incisions have healed well, and my mobility has returned, accompanied by minimal abdominal discomfort. Initially, I experienced some diarrhea and gas pain, but that has mostly resolved. Nonetheless, my persistent nausea, dry heaving, abdominal discomfort, heartburn, and excessive burping have not alleviated—and in many cases, have worsened since the surgery. Before my health issues, I stood at 4 feet 11 inches tall, weighing 118 pounds. Currently, I weigh only 87 pounds, which has led to concerns about being considerably underweight; a family member noted, “You look like you just escaped from Alcatraz,” a sentiment that resonates with me. Currently, I rely on anti-nausea medications and a limited diet, which I have jokingly referred to as "The Toddler Diet," consisting mainly of small portions of plain rice, chicken, lean steak, baked tilapia, pasta, chicken stock, toast, bananas, boiled carrots, zucchini, cucumbers, canned peaches, non-fat yogurt, Gatorade, and Clear Esures. Just three days ago, I attended a follow-up appointment with my surgeon and had my stitches removed. He expressed satisfaction with the healing of my incisions but was dismissive when I informed him that my symptoms persisted. He implied that my gallbladder was likely not the root cause of my issues. When I sought his advice on improving my diet, his response was somewhat dismissive, suggesting I simply eat whatever I wanted and endure any subsequent discomfort. I recognize that I am still at the early stages of recovery and that immediate improvement in symptoms is unrealistic. However, owing to my Cerebral Palsy and dependence on Medicaid, I am under pressure to comply with upcoming work requirements, particularly in my rural area where healthcare resources are limited. Therefore, I find myself facing a healthcare deadline of just six months, which is alarmingly brief. Given the connection between my gastritis and the diagnosed gastroduodenal reflux post-surgery, and given that sources from both the Mayo Clinic and Cleveland Clinic indicate that gallbladder removal can exacerbate reflux issues, they recommend considering diversion surgery or anti-reflux surgery if conservative measures like medication and dietary changes fail. Having been on Sucralfate and Pantoprazole for over a year, alongside adhering to a strict dietary regimen for two years, the decision to proceed with gallbladder removal was taken when previous measures proved ineffective. Now, with the urgency of my situation due to Medicaid constraints, I am contemplating the necessary steps to advocate for either diversion surgery or anti-reflux surgery if my condition does not show improvement in the coming months. Any advice on navigating this would be greatly appreciated. Thank you for your attention.

Answers (1)

7/7/2025, 1:10:50 AM

OpenHealth AI

I understand you're facing a challenging situation with ongoing digestive symptoms after gallbladder removal, alongside concerns about your weight and healthcare limitations. It's important to take proactive steps to manage your condition and advocate for the care you need.

Main Points:

1. Ongoing symptoms post-surgery could indicate the need for further intervention.
2. Consider practicality and urgency regarding potential surgical options, given your situation with Medicaid and limited healthcare resources.
3. Advocacy for your health is crucial, especially as conservative measures have not been effective.

Explanation:

Your symptoms, including persistent nausea, dry heaving, and reflux after gallbladder surgery, suggest a need for a closer look at other underlying issues, such as how your digestive system is currently functioning without the gallbladder. As noted by your sources, gallbladder removal can lead to worsened reflux and, at times, may warrant surgical options like diversion or anti-reflux surgery if medical management fails.

Next Steps:

1. Symptom Tracking: Keep a detailed diary of your symptoms, noting when they occur and any potential triggers (foods, activities, stress). This can help in discussions with your healthcare provider.

2. Nutritional Focus: While your current diet is limited, try to incorporate small portions of nutrient-dense food gradually if tolerated. Consultation with a nutritionist (if available) or an online support group might provide new ideas that align with your dietary restrictions.

3. Research and Prepare: Familiarize yourself with diversion and anti-reflux surgery options. Prepare a list of questions and concerns, highlighting your ongoing symptoms and weight loss, to discuss with your surgeon or another qualified healthcare provider.

4. Healthcare Advocacy: Given your urgent timeline with Medicaid, gather documentation of your medical history, treatments tried, symptom severity, and any changes in your health. This will strengthen your case when discussing treatment options.

5. Seek Support: Reach out to local organizations or support groups for those with chronic digestive conditions. They may provide you with additional resources, coping strategies, or potential connections to healthcare services.

6. Follow-Up: Schedule a follow-up appointment with your surgeon or consider seeking a second opinion from a gastroenterologist who specializes in post-surgical complications. Having a provider who understands your severity of symptoms and urgency can be vital.

Remember, navigating this journey can be complex and frustrating, but you deserve support and a clear path towards improving your health. Please let me know if you need further assistance or specific questions about these steps.