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Revision options for RNY gastric bypass


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#1 Suzanne-photog4fun

Suzanne-photog4fun

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  • Surgeon:The GREAT Dr. Charles Callery (RNY)
  • Hospital:Pomerado near San Diego, California
  • Height (ft-in):5-06
  • Start Weight:273
  • Current Weight:190
  • Goal Weight:155
  • Surgery Date:01/29/2002
  • Surgery Type:Gastric Bypass

Posted 28 May 2008 - 05:55 AM

Dr. Pleatman emailed me this discription of revision possibilities:

There are a number of options available for patients who have regained
weight after gastric bypass surgery. The first thing to do is figure out
why you have regained weight. Are you eating healthy? Are you "grazing,"
or snacking all day? Are you exercising? Only you know the answer to these
quesitons. If you are "misbehaving," an operation is not the answer. You
have to change your behavior.

Now, let's assume that you are trying to do the right things. Let's assume
that you have lost the feeling of fullness you used to have after a very
small meal. You get hungry sooner. You can eat much more than you used to.
In spite of doing everything right, you are regaining weight. If this is
the case, it is time to investigate what can be done. Perhaps your pouch
has stretched out. Perhaps the opening from the pouch into the Roux limb
(the stoma) has stretched out, allowing food to empty rapidly into the small
bowel. Perhaps there is a fistula (abnormal connection) from the pouch to
the excluded stomach. Each of these problems will have a different
solution. An upper GI series or endoscopy will help us decide which of
these, if any, exist.

Once we have this information, there are several options available, ranging
in complexity, risk, and expense. Here they are, sorted from highest risk,
greatest expense, and greatest likelihood of success, down to , least risk,
least expensive, and, possibly, least likely to succeed.

1. Complete un-doing of the gastric bypass, with conversion to vertical
gastrectomy and duodenal switch. This is the most complex operation, but it
adds significant malabsorption, which will help maintain long-term weight
loss. It is also the most dangerous operation, with the highest risk of
complcations. This can be done laparoscopically, but most likely would be
done "open."

2. Surgical revision of the pouch to make it smaller, with possible
revision of the anastomosis (connection of pouch to small bowel). Possible
lengthening of the Roux limb to increase malabsorption. This procedure is
somewhat questionable, and certainly not guaranteed. The main indication
for this procedure would be a fistula into the excluded pouch. Another
indication would be a very very large pouch which could not be shrunken by
other means. This can often be done laparoscopically.

3. Add a LapBAND. This is a fairly new concept, and currently there is not
much data available documenting long-term results. It may help by reducing
the size of the pouch, requiring you to eat slower, and helping you feel
full longer after eating. This operation can be done laparoscopically. Of
course, as with all gastric banding operations, it obligates you to having
lifel-long follow-up with your surgeon so your band can be monitored and
adjusted as necessary. Of course, this operation can generally be done
laparoscopically.

4. (Finally!) Endoscopic procedures.... procedures done through the mouth,
without any abdominal incisions. If you pouch is stretched out, it can be
reduced in size with the StomaphyX device. This device allows the surgeon
to place multiple fastners in such a way as to pucker in or pleat the
tissue. An enlarged pouch can be considerably shrunken in size. Another
option for shrinking the pouch is the ROSE procedure, which is another
device for placing sutures to shrink the pouch. If your pouch is not
stretched out, or is very small (as in the "micropouch"), your problem may
be that the opening into the small intestine is too big. This may be
treated by injecting a sclerosing medication into the tissue around the
anastomosis. This medication is similar to what is used to treat varicose
veins or spider veins... the medication is very irritating, and it causes
scarring and contraction of the tissue. These procedures, as I mentioned,
are all done endoscopically through the mouth, and have a low risk of
complications. None of the endoscopic procedures has a "track record."
There are no long-term studies. They are investigational, and not covered
by insurance companies.

#2 BabyNicole

BabyNicole

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Posted 28 May 2008 - 06:19 AM

Thank you for that info. Hopefully, I'll never have to use it. But if I do, I know where to come. ;)
Nicole :P
Surgery Date (Lap RNY)-06/23/08
Onederland: 7/29/08
Lost half of my desired weight: 9/20/08
Lost 80% of my excess body fat: 1/28/09
Height: 5'3"
227/133.5/135
Highest/Current/Goal