Jump to content


Photo
- - - - -

Causes of a stricture


  • Please log in to reply
12 replies to this topic

#1 LisaBoston

LisaBoston

    TT Master

  • Members
  • PipPipPipPipPip
  • 4,734 posts
  • Surgeon:Dr. Nohr
  • Height (ft-in):5-09
  • Start Weight:312
  • Current Weight:152
  • Goal Weight:180
  • Body Mass Index (BMI):22
  • Surgery Date:01/30/2006
  • Surgery Type:Gastric Bypass

Posted 22 November 2005 - 03:16 PM

Hello all. Here in Canada, on one of our on-line groups we are having a real debate on a stricture. So I thought I would come here for help.

The doctor that I am seeing generally has his patients come back after 6 weeks post-op for a scope to dialate the opening to the pouch as a stricture has occured. Many patients here are having this done as they tend to have problems with narrowning.

From what I have read in books and here, a stricture is a narrowing of the connection and is caused by scar tissue. Its something that we can't do anything about.

My doctor has his patients on liquids for 8 weeks post-op. Starting with clear fluids and working up to puree foods by the 8 weeks and then slowly introducing foods after this.

Has anyone heard of any other reasons a stricture is caused? This group here feels that by having liquids for so long after surgery, you allow the narrowing to happen as dense foods are not passed through your system.

They also talk about not worrying about protein for the first 8 weeks as your system doesn't tolerate it well, nor need it.

I know we are supposed to follow our doctors orders..and I agree with this, but have to wonder why such different information???

This doctor only does RNY Open, not Lap (yet).

Any thoughts? Lisa
Lisa
aka....Canadian Bear and her Canadian Bear Cubs!

Open RNY - Jan 30, 2006, Tummy Tuck - June 4, 2007
Century Club - Sept 12, 2006, Overweight Club - Oct 19, 2006
One-der-land - Nov 8, 2006,Below Goal - Jan 30, 2007 - 1st Anniversary Date!
Holding Below Goal - 2 year surgery anniversary! Holding at 155 :) - 3 year surgery anniversary (Jan 09)
Jan 2013- 7 year anniversary - 152

[SIGPIC][/SIGPIC]

#2 LarryB

LarryB

    Member

  • Members
  • PipPipPip
  • 45 posts

Posted 22 November 2005 - 03:34 PM

Well. I was on a liquids for 6 weeks. I don't know that I agree with the no food causes the narrowing. Scarred tissue happens in a lot of things. I know from a couple other surgeries I have had there has been a great deal of scarred tissue appear and I can guarantee the one area is always used and scarred tissue still formed. As for the protein I couldn't disagree more. Protein is essential to healing well. I know that myself I have never had problems with handling protien.
Larry

10/10/2005 Open RNY
444/247/260(personal)
Pre/cur/goal

#3 eyesthatkissu

eyesthatkissu

    TT Master

  • Members
  • PipPipPipPipPip
  • 2,352 posts
  • Surgeon:Dr. Callery
  • Hospital:Pomerado
  • Start Weight:315
  • Current Weight:150
  • Goal Weight:165
  • Surgery Date:10/24/2005

Posted 22 November 2005 - 03:38 PM

A stricture is caused by scar tissue. Period. Wether or not you have liquids or solids has little to do with it. There is no telling who will or who will not develop one. Statistically, there is no difference. Personally, 8 weeks of liquids is a little crazy. But every doctor is different. You should start protein as soon as you can tolerate it and the doctor advises you to do so. For us it's at 10 days post op. Maybe it doesn't matter, but I'm not willing to gamble with my muscles, or hair. You may have read my post about having difficulty finding a protein I liked. I can tell you that as soon as I did, I felt even better then I had before. And I was feeling pretty darn good. I'm not nearly as tired and I'm able to live completely like I was pre-op. So in a nutshell..... take your protein.:D
~~Robin~~

~~Dr. C was impressed by me!~~
315/150/165 ..... -112 inches, From a size 32 to a size 10. Below Goal :P 165 pounds no longer linger on my @*#!
October, 24 2005


Sometimes I feel like all I am doing is rearranging deck chairs on the Titanic :P
And in the end it's not the years in your life that count. It's the life in your years. -Abraham Lincoln

#4 VanessaSFL

VanessaSFL

    TT Premium Sponsor

  • Members
  • PipPipPipPipPip
  • 3,625 posts
  • Surgeon:Dr.Mark Liberman,Naples Florida
  • Surgery Type:Gastric Bypass

Posted 22 November 2005 - 04:02 PM

Scar tissue is what causes the stricture.
Some of us heal very well... too well at times.

Van
[SIGPIC][/SIGPIC]Van:)


Lap RNY March,21 2005
280/130

VPA BEAR

#5 LisaBoston

LisaBoston

    TT Master

  • Members
  • PipPipPipPipPip
  • 4,734 posts
  • Surgeon:Dr. Nohr
  • Height (ft-in):5-09
  • Start Weight:312
  • Current Weight:152
  • Goal Weight:180
  • Body Mass Index (BMI):22
  • Surgery Date:01/30/2006
  • Surgery Type:Gastric Bypass

Posted 22 November 2005 - 05:23 PM

I knew you would set the record straight. What do you do when you don't like broth....it makes me gag now. I can handle soups and even blenderized soups but straight broth...yuck.
Lisa
aka....Canadian Bear and her Canadian Bear Cubs!

Open RNY - Jan 30, 2006, Tummy Tuck - June 4, 2007
Century Club - Sept 12, 2006, Overweight Club - Oct 19, 2006
One-der-land - Nov 8, 2006,Below Goal - Jan 30, 2007 - 1st Anniversary Date!
Holding Below Goal - 2 year surgery anniversary! Holding at 155 :) - 3 year surgery anniversary (Jan 09)
Jan 2013- 7 year anniversary - 152

[SIGPIC][/SIGPIC]

#6 Phoenixfire

Phoenixfire

    TT Master

  • Members
  • PipPipPipPipPip
  • 1,641 posts
  • Surgeon:(Ret.) Alan Newhoff, Phoenix, AZ
  • Body Mass Index (BMI):19

Posted 17 July 2007 - 08:56 PM

Echo prior poster. I never heard of stricture until now, years after WLS. I did the cottage cheese and soft protein post WLS soon and had none. Seems that now stricture is so common and it puzzles me.


Open Roux-en-Y on October, 2002 - 7 year anniversary is right around the corner
Height: 5'8"
Highest weight: 300 lbs. with a BMI of 45.6 :eek:
Current weight: 140-145 lbs. and a size 6/8 with a BMI of 21.7 :D
Total weight lost after Roux-en-Y gastric bypass: 160 lbs. POUNDS!

#7 Dyann

Dyann

    TT Master

  • Members
  • PipPipPipPipPip
  • 3,356 posts

Posted 18 July 2007 - 04:28 AM

Strictures do not happen because you do anything wrong. It is not exactly known why, but the thought is that the area where the stomach and the intestine join up is lacking in a little bit of blood flow to the area (ischemic due to dividing the blood supply to that part during the surgery) which makes the healing process different and you get a narrowing and scar rather then normal healing. That is why they are usually started 4-12 weeks after surgery (Unless you are Vanessa who was diagnosed after over a year!!). It is a techinical aspect of surgery as there are different width openings a surgeon can make. Smaller ones have a better weight loss, but a higher stricture rate. Larger ones have a lower stricture rate, but also less weight loss.

One thing is for sure, the earlier it is caught, and the less it has narrowed at the time of treatment, the easier it is to treat and possibly the fewer dilitations are required.

In terms of the protein....I think fluids are more important right after, but you can get protein malnourshment easily and you need it to heal.

If a doctor is only doing open procedures, they are not really up on the standard of care. Doing it open is acceptable under certain circumstances, but is not the best for the patient. Think of this...if you needed your gall bladder out would you have it open for no other reason other than the surgeon wasn't proficient at lap?? You would find another surgeon as lap is lower risk and evolved into the standard of care as it is evolving for GBP as well. The only reasons to do GBP open from the start are numerous previous abd. surgeries or the only surgeon you can use only knows the open way. It is always acceptable to convert from lap to open intra op.

There is my 2 cents


__________________
[SIGPIC][/SIGPIC]DYANN

Lap RNY 1/4/06....
46/19.8/23.5 BMI's 167.9 pounds gone forever as of 9/12/07 116.3%to goal

294.4/126.5/150
5' 7''
Jupiter, Florida
Dr. Jefferson Vaughan: GBP
Dr. P Duddly Giles: Plastic surgeon TT/BL 03.20.2007

#8 fr1endly2

fr1endly2

    Member

  • Members
  • PipPipPip
  • 84 posts
  • Surgeon:Dr. Arif Ahmad

Posted 18 July 2007 - 12:01 PM

Well im not sure i always did hear its scar tissue...
okay but what baffles me is im 2 years post
op and go to my surgeons support meetings.
HIS patients dont get strictures.
NOW when i questioned the "Y"...
he said its in his technique that folks
dont get these problems.
SO who knows!!!!!!!!!!!!
cant say i ever heard it had to do with being on liquids
long cause ill say being in the WLS world for 2 years now....people
get them that havent been on liquids for 8 weeks....!!!!
LISA

NOTHING TASTES AS GOOD AS THING FEELS

LAP GASTRIC BYPASS SURGERY JUNE 1, 2005
START WEIGHT : 310
LOWEST WEIGHT: 167

#9 Work In Progress

Work In Progress

    Newbie

  • Members
  • PipPip
  • 11 posts

Posted 27 January 2010 - 03:16 PM

Ontario, Canada, GBS......had surgery done in Toronto.....had problems with
extreme nausea from the start and bad acid reflux.....had to wait 8 weeks for
healing period.....only had broth, yogourt, apple sauce, liquids....very little
amounts.....at 6 weeks I tried solids following the guidelines....I vomitted
every time I tried to ingest anything solid....

I vomitted daily for 5 weeks....my own family doc...told me to trust the surgeon.....I had to call the surgeon and told him I was literally choking on
food....he booked me for a scope and dialation....he corrected the stricture
.....I did have a narrowing which was causing the acid reflux....

At my 3 mos. visit...I told my surgeon that I still have trouble with solids or
anything with volume especially bread or pasta or any meats !!!!

He said many times he has to repeat the scope and correct the fixture a
second time......is this going to be a lifelong complication???? or am I just
one of the unlucky ones????

Have you ever heard of repeated scopes and repeated strictures???????

#10 Phatlady

Phatlady

    Senior Member

  • Members
  • PipPipPipPip
  • 1,423 posts
  • LocationNEWTOWN, CONNECTICUT
  • Surgeon:DR. NEIL FLOCH
  • Hospital:NORWALK, CT
  • Start Weight:303
  • Current Weight:172
  • Goal Weight:145
  • Body Mass Index (BMI):50+
  • Surgery Date:10/19/2009

Posted 27 January 2010 - 07:06 PM

First of all there are several reasons why Strictures are caused and scar tissue is not the only one.
If you look on this site-Ask Dr, Callary, he responded to my question about causes and since he is a surgeon, you should read his response.
I just had my 3 rd Dilation today, so I am becoming an expert in strictures. And yes, you could have to have dilations many, many times.
Everyone is different, every patient's surgery and healing process is different.
My surgeon admitted to making the opening too small-(no one is perfect...), but there are non surgical reasons for tightened openings, often due to the health or healing process of the patient.
I am happy to hear a surgeon state he has never had a stricture with a patient but I think statistically, it is just a matter of time. My surgeon had not seen one in ages and did not believe it was my issue until the GAstric guy went in to find I had a pin head opening.
The negative side of strictures, other than the hospital and doctor visits, is that you can tear. My second dilation I tore and this third dilation I tore and had to have a staple inserted to repair it.

As for food, you should not be pushing solids through the opening that would stretch it out, so that should not be an issue. A Liquids and semi-liquid diet for two months is fine as long as you push the protein. I have basically lived on that type of diet for three months but I get between 70-100 grams of protein a day. Without protein, you will get very weak and potentially very sick.
I would never say this but if your doctor does not push the importance of protein after the second or third week post-op, you need to find a new doctor as this one has not read the literature, LOL!

#11 rsw

rsw

    Senior Member

  • Members
  • PipPipPipPip
  • 552 posts
  • Age:38
  • Start Weight:205
  • Surgery Date:05/04/2010
  • Surgery Type:Gastric Bypass

Posted 27 January 2010 - 08:02 PM

Great info. Thanks everybody. Phatlady, thanks for that post. So sorry you've gone through so much with this. Hopefully you're at the end of the rope with this. Good luck!
Roxy


Banded Feb 2004, Band revision Feb 2007, Revised to RNY May 2010


DOS/Current/Goal [updated 5/18/11]

200/160/130

#12 Work In Progress

Work In Progress

    Newbie

  • Members
  • PipPip
  • 11 posts

Posted 28 January 2010 - 07:45 PM

Thanks for your response..........I will read the article you suggested by the
doctor......3rd dialation for you......OMG

Did you have symptoms of the tearing....or did the doctor tell you afterwards?
Will it always be a problem for us???????? I hope not.......

I'm losing a lot of weight fast.......75 lbs in 4 1/2 mos........but I'm weak, tired, I can go all day without eating and without feeling hungry.....this isn't
normal?????? I'm 5 feet tall......so weight loss looks drastic...but I'm afraid
of getting sicker!!!!

#13 Phatlady

Phatlady

    Senior Member

  • Members
  • PipPipPipPip
  • 1,423 posts
  • LocationNEWTOWN, CONNECTICUT
  • Surgeon:DR. NEIL FLOCH
  • Hospital:NORWALK, CT
  • Start Weight:303
  • Current Weight:172
  • Goal Weight:145
  • Body Mass Index (BMI):50+
  • Surgery Date:10/19/2009

Posted 29 January 2010 - 09:02 AM

Thanks for your response..........I will read the article you suggested by the
doctor......3rd dialation for you......OMG

Did you have symptoms of the tearing....or did the doctor tell you afterwards?
Will it always be a problem for us???????? I hope not.......

I'm losing a lot of weight fast.......75 lbs in 4 1/2 mos........but I'm weak, tired, I can go all day without eating and without feeling hungry.....this isn't
normal?????? I'm 5 feet tall......so weight loss looks drastic...but I'm afraid
of getting sicker!!!!


The tearing during dilation is something you want to avoid at all costs. But it can happen any time you are dilated-it is a risk.
The Gastro Dr. will tell you there is a possibility but they will do everything they can to avoid it as you could wind up in the OR in emergency surgery. They have repeated this to me as much as I heard "death" prior to GB surgery itself.
They place a clear balloon into your opening and stretch the stricture that way so although they are as careful as can be, it is a rather forceful stretching.
I woke up DURING the first one and it felt like a dozen pitchforks being shoved down my throat, I was gagging as they held me down and then they knocked me out. The dilation went well but they could not open me that far up since my original opening was so small.
The second dilation I slept through entirely, thank goodness, but I did tear and afterwards I felt pretty nauseous and very sore for about five days. I felt tender in my throat and my pouch. I was also very pale and very knocked out for almost a week.
This third time, I awoke as they were dilating me and I think I caused the damage that needed a staple repair, by my squirming-although that was not conscious-I felt discomfort and I was wretching and it felt like my whole body was gagging-not fun. My gag reflex was in full force.
Afterwards in recovery, they gave me water and I threw up a little blood. I am three days out and still feel very tired and sore and a little crappy.
I am hopeful that this is the last necessary dilation but my original opening was so small, I can not be certain.
I have been warned every time I see the surgeon or the Gastro Doctor that other dilations could be in my future. The goal of my Gastro Dr. right now is to get me to be able to eat solid foods.
The original endoscopy is a walk in the park because although they scope you, they do no harm. Dilations are stretching your stricture and so they at the very least cause a little tenderness.

As for your weight loss and weakness, you must never go a day without regular food and water-ever, ever. You can make yourself very sick. Even if you don't feel like it you must drink all day long and you must push the protein. If you are not eating things-then drink two, or three, whey or isolate protein shakes a day, minimum. Your body needs this to function. You are weak because you are not feeding your body the bare minimum. You should not feel weak after GB surgery and you won't if you feed your body the necessary nutrients. Start your day with a protein shake, drink water, water, water, get protein at lunch, drink another shake as a snack and push protein at night or drink another shake before bed.
If you really don't feel like eating, or you hate shakes, bring protein bars with you and nibble on those-find a 15-30 gram protein bar but keep a close eye on the sugar content in the ones you buy. Your weight loss is great but our energy level should be increasing, not decreasing. Your body is telling you it is not getting what it needs and remember, if it does not get the proper fuel, you will be losing your muscles, and not your fat and your heart is a muscle.
Years ago my nutritionist had a Gastric Bypass patient referred to her, she was 24 years old and she had a heart attack as she had not been following the nutritional guidelines post-op.
Your weight loss amount is in the normal range, I am three months out and stalled again but I have lost 70 pounds.