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Massive weight gain after pouch dilation :-(


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Hi

 

Just joined - I hope this post is in the right place.

 

I was banded in 2006 by The Hospital Group and the weight loss was awesome. I reached my target weight a few years ago and maintained it for a while. However I was seriously ill in 2012 (not band related) and felt I couldn't get enough nutrition in order to recover properly, so I paid to have the band completely aspirated.

 

What a mistake that turned out to be. Immediately I could, and did, eat as much as I wanted whenever I wanted. Four or five months later I started having my band filled up again. I was getting no physical restriction, and at that time didn't know that I wasn't supposed to be looking for a physical restriction but a dimming of the appetite. (I was always physically restricted before I had it emptied). Eventually I reached the point where I got physical restriction, but in no time I was able to eat more and more. After going to my doctors because I had chronic and intense heartburn, and was able to eat far too much despite the band, I had barium swallows and an endoscopy which revealed a dilated pouch and an oesphagus that was starting to dilate too because the food volume was working its way back up my gullet!! :-o The response from my bariatric team was to completely empty my band and see how things went.

 

The latest barium swallow showed that despite some reflux, everything else was back to normal. My pouch had shrunk again, and my oesphagus was looking how it should.

 

I had my first fill last week and, at 4ml, I expected some restriction. When I first had the band filled I felt a difference at 3ml. I am still feeling chronically hungry - to the point of nausea if my appetite isn't satiated. I spoke to my band nurse this morning who told me that I wouldn't feel any restriction at 4ml as I had 7.8ml in before.

 

I am surprised that I feel no restriction. Everything I have read so far on various gastric band forums has said that once the pouch dilation happens, things are never the same and people end up having the band taken out.

 

I am not stuffing myself with chocolate, cakes, crisps and sweets but I am still seeing alarming weight gain despite my relatively healthy eating.

 

I am around 15.5 stone (220lbs, 100kgs), which is 150 percent what I weighed two years ago and I feel distraught. :-(((

 

Has anybody here experienced a pouch dilation leading to oesphagitis, and had to have an unfill then a refill - and if so, how did you get on?

 

Nicola

 

Ps. Sorry for the long post. :-)

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Sorry to hear you're dealing with this. I had the same issues for years. The reflux got so bad that my band was emptied and I was revised to RNY in March. My surgeon has done over 4000 bariatric procedures and will no longer do bands as he says over half of them end up being removed within 8 years. It was a terrible hassle but I'm very pleased with RNY. I've been much more successful this time around.

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Hi

 

Thanks for the reply - much appreciated.

 

I have a couple of questions though - when you said you had been dealing with the problem for years, are you referring to the reflux only? Did you have the band emptied, then refilled with continuing weight gain? I am worried that I have damaged my pouch so much it has become elastic and the same problem will recur with no other option but to remove it. I am not at a weight (and never have been) that our national health service would consider a serious enough health risk to warrant surgery. (I paid for original surgery privately to stop the ongoing battle with yo-yo dieting and the misery both dieting and my weight caused). I have gained 75lbs in the last two years, most of it in the last year - and since the unfill I gained 6lbs - that was over the course of four weeks.

 

Also... what is RNY? (I'm from the UK so may use different terminology or I could just be being dim!)

 

Nicola

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I paid for the band surgery myself also. I lost significant weight but always felt an uncomfortable mechanical restriction and was back and forth to Dr getting fills/unfilled constantly at considerable cost.I'm unfamiliar with some of the medical terminology you used but my issues were,besides reflux, my stomach had worked its way up through the band and a hiatial hernia. The band was emptied in the hope that things would go back to where they belonged. They did not. I gained most of my weight back as my stomach was large due to the band slippage. I gained weight regardless of the fill level at this point. In 7 years I never did get a fill that was comfortable. Due to the results of my upper GI in combination with my BMI (41), my insurance approved band removal, hernia repair and gastric bypass (RNY). I was worried that I had damaged myself permanently but the surgeon was able to perform all 3 procedures at once. I couldn't be happier.

Hope that helps. Feel free to pick my brain

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I gained weight regardless of the fill level at this point

 

Yeh that's what I'm worried about, and that's what I have read over and over on the other boards - that once the band is emptied after a pouch dilation it never works again. I just wanted to check here in case there was someone that says it worked ok (have never read that!).

 

Yikes! I think I'll probably have to live with my additional weight (and then some) unless our UK surgeons look on me kindly. The consultant I saw said that although my BMI is usually too low for weight loss surgery (I think unless you are morbidly obese you won't get it without paying for it privately in the UK), he would suggest a bypass to the surgeons should the band not work, and that was because of the rapid and intense weight gain over the course of two years (80lbs).

 

Here's hoping I am a walking miracle and it does work for me - or that I get a bypass. :wacko:

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To be clear I'm not sure if my band worked. After the slip occurred the reflux was so bad that I used high calorie liquids to combat it. In truth I never liked the band. For me it was torture. You seem to have had a much better experience and I hope that continues. Here in the states they consider reflux dangerous and in combination band slippage my insurance approved revision even though I barely qualified by weight. What is your current BMI?

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I am still feeling chronically hungry - to the point of nausea if my appetite isn't satiated.

BTW this sounds reflux related to me and is the main reason I pumped milkshakes and soups down my gullet for years.

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Banding was a fantastic experience for me, for the first six years. It was after I had become ill (a haemorrhagic stroke) and I had it emptied, that all my woes began.

 

By the way, the bariatric team don't think it has slipped - it doesn't look like it from the xrays they have done.

 

I ate like a pig for a few months post stroke. My body seemed to be starving. Indeed, in the preceding six months to my stroke the weight dropped off at a ridiculous pace. I'm pretty sure this was because of stress rather than the band as my weight loss had been slow and steady for years before.

 

My fills were started again perhaps 4 months or so post stroke and done over the course of about year to get it up to where I was before my stroke. It was probably during this phase of having it emptied till it reached my old 'sweet spot', that I did the damage to my pouch. But who knows.

 

About six months ago I noticed I was able to eat wayyyyyy more than I was used to even though I was at my old band restriction. And about three months ago I saw my doctor about the weight gain and constant reflux, which is when my consultants discovered the dilation.

 

And here I am - now back at 4ccs and due another small fill in a couple of weeks. I just don't know what to expect long term. I am dreading finding out I have no suppression of appetite whatever the fill is - I can do without the physical restriction (I think).

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BTW, I take omeprazole for my reflux and as a result I don't experience any of the physical symptoms of reflux, such as the burning sensation - so I don't know that the chronic hunger and nausea would be caused by reflux when it isn't showing symptoms.

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What do you mean by dilation? I'm not familiar with that term in that context.

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Dilation means enlarging of and stretching of the pouch so a pseudo stomach forms above the band - so in effect you have two stomachs - a before and after band stomach. My consultant says food rots in there and eventually drips down through the band. Yuck! :blink:

 

Eventually, if you over stretch your newly enlarged pouch (which I did), the food starts backing up your oesophagus and causes oesophagitis, or swelling of the oesophagus, which can start belling out (which mine did). It was worrying for the consultant which is why I was immediately emptied - apparently damage to the oesophagus can be pretty serious if it's left too long eventually leading to an inability to swallow. :eek:

 

All together, not an ideal situation for anybody to be in. <_<

Edited by NicolaT
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I forgot to say, the BMI calculator said I am at 32.7. I should be pleased with that, but the lower my BMI, the less likely it is that they will replace my band if it fails - they may just remove it altogether. :mellow:

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Wow I wish I could be more helpful. My whole RNY process was very quick. Five weeks from the referral from PCP for upper GI to surgery so I missed some of the diagnosis. I had a hiatial hernia and a large pouch. Not sure if it was 100% due to slippage as I'm sure I stretched it out as well. As for BMI I was asking to see where you stood as far as qualifying for revision. Here in the states I think the standard is 35 with co morbidity. Reflux qualified in my case as did back pain. I hope everything works out for you

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As you were typing that I was at our NHS site which said exactly what you just said about your qualifying criteria in the US. It's the same here.

 

I hope the fact that I am already banded would go some way to helping me. If they're already performing invasive surgery to remove the band hopefully they will give me an alternative even though I am still 22lbs short of the qualifying criteria for weight + comorbidity of 35 BMI. (I satisfy the comorbidity criteria I think).

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Do you know whether it is possible to stretch a bypassed (or sleeved) stomach?
The experienced with my enlarged pouch has frightened me and made me wonder whether the same thing could happen if I had a bypass.

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Not to make light of the situation but I could gain 22 lbs in a month. I love the new me. Down over 80 in 4.5 months. All weight related issues resolved including the back surgery my PCP was 100% convinced I needed. At 32 bmi I suppose you could decide to lose.

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Do you know whether it is possible to stretch a bypassed (or sleeved) stomach?

The experienced with my enlarged pouch has frightened me and made me wonder whether the same thing could happen if I had a bypass.

I'm sure you could but it's so small to start with. Mine was less then 1/2 cup and still holds far less than a cup of proper food
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My surgeon suggested the gastric bypass for the severe reflux (GERD) I had - my esophagus was shredded and I could no longer talk - and it worked like a charm - its all gone.  He doesn't even do the band (most doctors don't any longer - too many long term issues).  My stats were actually a little under the requirements too but he was able to convince the powers that be (the insurance company) that the bypass (RNY) was the only way to fix me and keep me fixed - and they finally approved it.

 

Everyone is different and there can never be any guarantees but from what I have read and the conversations with the surgeon I've had - if you follow the program on either the bypass or the sleeve - you will be in good shape - but remember this has to be a life long committment - its mostly the band that causes problems

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At 32 bmi I suppose you could decide to lose.

:huh: What does this mean?

 

Thanks for the post Patty - I had started losing my voice - that only stopped a few weeks ago, after my band had been deflated for a while. In fact it wasn't until you mentioned it that I noticed I don't have the hoarseness anymore. :)

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At 32 bmi losing weight the old fashioned way would seem feasible. I know for me though losing was easy. Keeping it off was very difficult. My point was that, if it were me, I'd gain the weight to fit the criteria. I'm not necessarily advocating that approach but RNY has literally saved my life. It's not a magic pill but I'm very pleased with the results so far. By grace I had already gained enough weight to qualify.

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At 32 bmi losing weight the old fashioned way would seem feasible.

 

I tried that way for 20 years - as many others have I would think. I started my weight loss journey aged 18 and just 156lbs and over the course of 20 years (and many many diets later) I weighed approximately 240lbs. Still a lightweight compared to many other weight loss candidates, but I was obsessed with dieting and how bad I perceived I looked during those 20 years. It was a massive relief not to have to think about that anymore.

 

 

if it were me, I'd gain the weight to fit the criteria

 

I can't say I haven't thought about that. Sadly it would take me less than six months to gain that naturally if I was unbanded, and that would be if I was being careful! :wacko:

 

:)

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