Question:
I NEED HELP UNDERSTANDING THE OUTLET SIZE/POUCH SIZE
I had four endoscopys run last year. The third endoscopy, my outlet was stretched to 18mm. NOTHING has been the same since!! The fourth endoscopy revealed it had closed to 16mm. I lost 4 pounds in five months. I had an upper GI run, the pouch size is 1.5 ounces. The outlet is still at 16mm. The surgeon is telling me the outlet size doesn't matter. I am suffering from severe malabsorbtion. I was told the answer was to operate and lengthen my instestines. I have read it will slow my weight loss. I also was told I would "relieve myself" 3-6 times per day even up to "extreme", if you know what I mean. What is the optimal size for the outlet? I was originally told 12mm-14mm. What is the optimal size for the pouch at 11 months post-op? I am upset. Can anyone help me out here? Thanks!! — amytravis (posted on June 4, 2003)
June 4, 2003
My surgeon said that it should be between 10-12mm. He also said that if it
was too large I would feel hungry all the time. I had an EDG (endoscopy
and dilitation)done last month because I was too small, only 4mm.
— jerzeygirl71
June 4, 2003
I belive the max is 15 - I dont have my notes with me. BUT to 'big' a
stoma and it renders your pouch useless. A large stoma will allow food to
bypass your pouch and go directly into your intestines. This will allow for
'overeating' and no food limiations. Long term in order to maintain YOU
will have to diet and excerise. To large a stoma is something that surgeons
have 'know' about for years, failed to fix and try to 'blame' their
patients ... most just revert their paitents to diet and excerise. I cant
belive your surgeon would say the stoma doesnt matter - it certainly does!
Malabsorption or malnutrition? The malabsorption part of your surgery
would be is the 'window' part of the surgery and would stop about 18 months
post.... Not sure what is going on with you.... would need more
information; but back to the stoma outlet... I have had a large stoma from
day one; my upper gi showed no pouch function at all.. I have no food
limiations that are associated with the surgery.. I have yet been able to
get this problem fixed. Taking down the stoma is very risky and 99.9%
surgeons will not do it. Right now my current surgeon is looking into using
the lap band to 'fix' the stoma outlet.
— star .
June 4, 2003
Assuming that you had a Roux-en-Y, your pouch should be about 1 oz with a
small stoma to facilitate the food staying in your pouch longer, your
feeling full longer and your being able to avoid hunger. I can't help but
think that your surgeon is not being entirely honest with you-- perhaps
it's from his lack of experience (which happens) or from callousness. As
of for having to relieve yourself excessively, that is the problem that
many patients w/ the DS/BPD; from what I understand it is a problem that
you are right to want to avoid. At this time, have you considered getting
a second opinion? It might be worth it for you, if only for the peace of
mind.
— SteveColarossi
June 5, 2003
I read/heard that around 11mm is the standard size for the stoma...the size
of an M&M. Your pouch is small at 1.5 oz (at 11 months out), but it
doesn't matter how small your pouch is when your stoma is too big; the food
goes right through and into your intestines. I assume you're hungry a lot.
The stoma/outlet size ABSOLUTELY matters. I've never heard of someone
stretching a stoma to 18mms, nearly twice the standard size. To me, it
sounds like your surgeon is grasping at straws by saying the solution is to
lengthen your intestines (or shorten your bypass). The problem seems to
lie with your enlarged stoma...(just my humble opinion, and I'm not a
medical professional) I would consult with another doctor (get a referral
and find someone who is VERY skilled in RNY) if I was in your shoes, before
undergoing any more surgeries. Hugs and best wishes, Joy
— [Deactivated Member]
June 5, 2003
I will give you as much info as I can. I have severe malabsorption-more so
than the roux-en-y is supposed to create. It appears to me that the stoma
is too large and letting food pass out of the pouch too quickly. I have
pain intestinally after I eat. I have stuck to the program, but I feel
like my body won't let go. It would appear it has gone into starvation
mode because it is uable to get the nutrients it needs. I just fail to
believe I have to "relieve myself" even to extremes, 3-6 times
per day as a possible "solution" to a problem the doctor who ran
the endoscopy created. I had a problmen with my stoma closing up, not
stretching. He did that part. The surgeon did tell me that fixing the
stoma was more dangerous than doing the other procedure. I guess the
procedure is UTGANY. The surgeon has blamed me for the whole thing. I
don't think that is right!! Even the doctor who did the endoscopy said the
most the stoma should be is 14mm or you will dump. I go for a second
opinion June 17. I am just really upset. I had this done to improve my
life.
— amytravis
June 5, 2003
Just a question, Amy...how do you know you're suffering from severe
malabsorption? Are your labs totally off? Also, how long is your bypass?
Just wondering...
— [Deactivated Member]
June 5, 2003
I think you are talking about two different problems here. The size of the
stoma has nothing to do with the malabsorption issue. The amount of
intestine bypassed is what causes malabsorption-the more bypassed (length),
the more malabsorbtion (is it P or B?? I never know how to spell
malabsorb(p)tion). Blood tests can tell the doctor how severe the
malabsorption is and provide you with supplements that you can take, such
as vitamins, to provide you with what you need to prevent that. Some
distals take much more supplements than the proximals to ensure that they
get enough nutrition and vitamins. Lengthening your intestines will
certainly cut down on the malabsorbtion, but again has nothing to do with
the stoma size. Are you hungry all the time and never seem to feel full?
If so, then the stoma is probably enlarged, and if not, then it is not too
large. As for pouch size, originally they start at anywhere from 1/2 an oz
to 3 or 4 oz- doctors make them different sizes. Ask your surgeon what the
starting size was. 1.5 oz is pretty small for 11 months but is actually
better than it having stretched too much which would cause you to have to
eat more to fill it. I'm not sure what the average size is for 11 months
but by 1 year-18 mo, most have somewhere between 6-8 oz, some smaller, some
larger.
— Cindy R.
June 8, 2003
The only labs that were run were ones I have requested. My surgeon is not
running labs periodically. I had heard that was terribly important. I
also feel the food is passing right through my pouch. I am hungry all the
time. I so appreciate your help. I don't want to have an operation that
has no hope of solving the problem. Someone posted the outlet is too
dangerous to fix. Does anyone know if that is true?
— amytravis
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